1983, 12-16 Permit: 83B-2575 Plumbing Fixtures PLAN NUMBER APPLICATION/PERMIT PERMIT NUMBER
SPOKANE COUNTY — DEPARTMENT OF BUILDING &SAFETY 636, -- ' 51
NORTH 811 JEFFERSON /SPOKANE,WASHINGTON 99260/ (509)456-3675
APPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 3 COPIES
STREET ADDRESS PARCEL NO.
1. . 112101 ST4t
LOT BLOCK SUBDIVISION LEGAL DESCRIPTION:
2.
OWNER PHONE PHONE
3. i1Ac vg-LI1 ?:C (2.601J GOO — Zr512
MAILING ADDRESSaZIP Actual Set Backs in Feet to:
'. 1 11'2,LJ -1T ci q ZcTe North 'South East I West
CONTRACTOR LICENSE EXPIRES PHONNE4^ -74g Size of Parcel Zone Classification Residential❑
4. O IIVA1B ( ' �' I`T I Commercial❑
ADDRESS ZIP ^ Type Const. Occupancy Sprinklered
c.�
-0"41447=1:=2204
— r G� Imo/ 1 51-5U J$ lIP9Q /7 ❑Yes ❑No ❑Req'd.
DESIGNER PHONE New Const.Valuation Remodeled Valuation Total Bldg.FioorArea
5. ADDRESS ZIP Main Floor Upper Floors Garage/Storage Greenhouse
CHANGE OF USE FROM TO Cover Deck Uncv.Deck Fin.Basement Unf in.Basement
6.
No.Baths No.Floors No.Fin.Rooms No.Dwellings
TYPE ,2(NEW D ALT. ❑ AD'N. ❑ RPL. ❑ MVE.
7. OF ❑ OTHER
WORK ❑ BLD. ,PLMB. ❑ MECH. ❑ M.H. ❑ POOL Certifi.of Exempt. Required Yes No❑ Number
or Variance Received Yes❑ No❑
•
DESCRIBE WORK t Shorelines/Flood Hazard Plans Required❑
8.
}�GUi'Yli',t06 cj.)Ottt(--+ Yes Not Applic.❑ Received ❑
VALUATION SOURCE GAS ELECTRIC WATER
SEWAG Ownership FEES COLLECTED
9 RIVAT£p SEWER❑
UTILIOTIES Public❑Private❑
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 Building
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 p�
of construction.SEE REVERS IDE FOR REQUIRED I SPECTIONS Plumbing
� �
SIGNATURE OF APPLICATI N g
OWNER OR AGENT/i 6--� . K DATE �2— ��r! Mech.
SPECIAL APPROVALS SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
Plan Check
PRELIM. FINAL DATE
Env.Health 1 . C . SEPA
Planning I ` Lt' ) . Modular/
i � MFG.Home >-
Prevent.Fire
l w//—zb� rnA G
Engineer Other(Specify) W
5i Other
Utilities /�(AJ�
I -- Sf�/ Iv TOTAL $ G • ..i
SEPA .. /.::
WHEN MACHINE VALIDATED IN THIS SPACE,
Plans PERMIT IS NONTRANSFERABLE THIS BECOMES A PERMIT.
Exam. PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
Tech. 0 1
Building I / DATE
IN 180 DAYS 1E l 6 -8 3 PERMITrIQ5 7.5 z * 2 5, 0 0,6�1L
JJ 16