1983, 04-19 Permit: 83A-3062 Plumbing Fixtures PLAN NUMBER APPLICATION/PERMIT PERMIT f�NUMBER
111 SPOKANE COUNTY — BUILDING CODES DEPARTMENT -P73r - 3°'2'
NORTH 811 JEFFERSON / SPOKANE,WASHINGTON 99260 / (509) 456-3675 DATE
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 4 COPIES
JOB ADDRESS yam' //0, .2 Y
F`�+ L✓ -�. LEGAL DESCRIPTION — SEE ATTACHED
1 LOT BLOCK SUBDIVISION PARCEL NUMBER/S
2 OWNER PHONE
3.
ADDRESS ZIP Required Set Backs in Feet C 3 * * 1 7. 0 0
North 'SouthEast West * i 7 9 0
CONT& R P ONE Size of Parcel Zone Classification
�� 4-�'�L .� 014-7—..‘.' .-. �4- 7 ,
4.
ADDRESS 3 � �/ ZIPy/•/J� Type Const. Occupancy Sprinklered _,
_....s -0(---- / /2�r� ❑Yes ❑No ❑ Req'd. J (.; 6. I :;;'
DESIGNER PHONE Valuation Building Area in Sq. Ft. i, (I. _ 1 9-0 3
5.
ADDRESS ZIP DWL Area Basement Area Garage Area Storage . 6. C 7 9 —
CHANGE OF USE FROM TO Split Entry Split Level Rancher
6.
TYPE No. Baths No. Floors No. Rooms Rec. Room
❑ N6.W LT. ❑ AD'N. ❑ RPL. ❑ MVE.
7, OF ^ ❑ OTHER Req'd. Recd. Not Req'd.
WORK ❑ BLD. �s.-PL-01—. El MECH: ❑ M.H. ❑ POOL CERTIFICATE
of EXEMPTION
DESCRIBA WORK
83. I X+UReS FEES COLLECTED h
VALUATION Source GAS ELECTRIC WATER SEWER
of
9
Utilities
Single $
I hereby certify that I have read and examined this application and have read the "NOTICE" provisions included
on reverse side, and know the same to be true and correct. All provisions of laws and ordinances governing this Building
type of work will be complied with whether specified herein or not. The granting of a permit does not presume
to give authority to violate or cancel the provisions of any other state or local law regulating constructio or the
performance of construction. Plumbing
DATE 1, // SIGNATURE " -'9-' -4,--44'74„ "
h.
SPECIAL APPROVALS SPECIAL CONDITIONS:
DEPT. REQ'D. REC'D. Plan Check
Env.Health f�
I �{— /�C1.--6f SEPA ccc)
Planning
U
� ��� Lu
0.
Fire Marshall Mobile Home
Z
Co. Engineer / /'/� �-- Other (Specify)
Utilities TOTAL $ / f i
Zone Clearance
WHEN MACHINE VALIDATED IN THIS SPACE,
SEPA Checklist ,/ pp aa ,TH E {Q•p�4�ES ERMIT. `'
r �/4 OFF410 �' y7 �� 306,25 *17,lY0ag
DATE//
// APPRII I FOR ISSUANCE