1984, 01-13 Permit: 84A-387 Plumbing FixturesAPPLICATION/PERMIT
SPOKANE COUNTY - DEPARTIVIENT OF BUILDING & SAFETY
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
1.
2.
STREET ADDRESS
LOT
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
�/-7 //7 SM
BLOCK I SUBDIVISION
OWNER
MAILING ADDRESS
PARCEL NO.
// 9/4_ /7 /A
IPHONE
CONTRACTOR1LICENSE EXPIRES
4. �''7.7)
ADDRESS
// I /.' — .fie "eh
5.
6.
DESIGNER
ADDRESS
PHONE
PHONE
LEGAL DESCRIPTION:
Actual Set Backs in Feet to:
North I South East I West
Size of Parcel Zone Classification
ZIP
PHONE
Residential ❑
Commercial ❑
I Occupancy P Y I Sprinklered
11 ❑Yes ❑No ❑Req'd.
New Const. Valuation
Type Const.
CHANGE OF USE FROM TO
ZIP
Main Floor
Cover Deck
TYPE £ NEW ❑ ALT. E AD' N. ❑ RPL. ❑ MVE.
7. OF
WORK ❑ BLD. 41'PLMB. ❑ MECH. ❑ M.H. E POOL
8.
9.
DESCRIBE WORK
VALUATION I SOURCE
UTILITIES
F
GAS ! ELECTRIC
❑ OTHER
WATER I SEWAGE
PUBLIC 0 SEPTIC 0
PRIVATE ❑ SEWER 0
No. Baths
Certif1. of Exempt.
or Variance
IUpper Floors Garage/Storage I Greenhouse
Uncv. Deck I Fin. Basement
Remode ed Valuation Total Bldg. Floor Area
INo. Floors I No. Fin. Rooms
IRequired Yes❑ No
Received Yes❑ No❑
Shorelines/Flood Hazard
Yes NotApplic. ❑
Ownership
Public 0 Private 0
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 type of
work will be complied with whether specified herein or not. The granting of a permit does not presume to give au-
thority to violate or cancel the provisions of any other state or local law regulating construction or the performance
of construction. SEE REVERSE SI • E FOR REQUIRED INSPECTIONS
SIGNATURE OF _ APPLICATION ,
OWNER OR AGENT - DATE
SPECIAL APPROVA S
PRELIM. FINAL DATE
Env. Health
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
gR"
SPECIAL • DITIONS: (SEE REVERSE SIDE FOR NOTICE)
A M..,
/,.
-
PERMIT IS NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
Unfin. Basement
No. Dwellings
Number
Plans Required 0
Received 0
FEES COLLECTED
Building
Plumbing 36-G
Mech.
Plan Check
SEPA
Modular/
MFG. Home
Other (Specify)
TOTAL $� 'G
PERMIT NUMBER
4-f\ -
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
L
DATE I S ED =84
38.72
PERMIT NO.
*55,00
TOTAL