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1984, 02-28 Permit: 84A-1642 Plumbing Fixtures PLAN NUMBER APPLICATION/PERMIT PERM T NUMBER SPOKANE COUNTY - DEPARTMENT OF BUILDING & SAFETY 4. - 1 (r 42__, NORTH 811 JEFFERSON /SPOKANE,WASHINGTON 99260/(509)456-3675 APPLICANT: COMPLETE NUMBERED SPACES- PRESS HARD TO MAKE 3 COPIES 1. STREETADDRI-_SSS y 9 PARCEL NO. LOT BLOCK SUBDIVISION LEGAL DESCRIPTION: 2. oliN"' "V I f2_— I PHONE 3-7 3• G/% I� p Actual Set Backs In Feet to: M [Nil ADDRESS _Q 4 ��� North [South East I West CONj �T LICENSE EXPIRES PHONE Size of Parcel Zone Classification Residential❑ ^/I Commercial❑ 4. ADDRESS ZIP Type Const. Occupancy Sprinklered ❑Yes ❑No ❑Req'd. DESIGNER PHONE New Const.Valuation Remodeled Valuation Total Bldg.Floor Area 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 TYPEW ❑ ALT. ❑ AD'N. ❑ RPL. ❑ MVE. 7. OFCIOTHER WORK ❑ BLD. JZPLMB. ❑ MECH. ❑ M.H. ❑ POOL CVai�ooffExempt. Required Yes❑ No❑ Number Received Yes❑ Non 8. DESCRIBE WC,_ �� Shorelines/Flood Hazard Plans Required❑ c- Id t-- Yes Not Applic.❑ Received ❑ VALUATION SOURCE GAS ELECTRIC WATER SEWAGE Ownership FEES COLLECTED 9• UTILOITIES PUBLIC 0 PRIVATE 0 SEPTIC 0 SEWER 0 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 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 A=1-42 of construction.SEE REVSE SIDE FOR REQUIRED INSPECTIONS Plumbing SIGNATURE OF APPLICATIONS v20 y y OWNER OR AGENT �,a� DATE O Mech. SPECIAL APPROVALS SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE) ` r Plan Check PRELIM. FINAL DATE 1 �.1.-r li IV " Env.Health �� L-4A_V CirJ1 SEPA Planning I f�j�j(���2. Modular/M G.Home >- , Fire /)J ''O Prevent. i C..1 G Other(Specify) W Engineer `Zi ...Ii VAI/1/414 el Lt Utilities 1"1-(- 1� 1201 I w TOTAL $ ‘ ••—• —• SEPA WHEN MACHINE VALIDATED IN THIS SPACE, Plans PERMIT IS NONTRANSFERABLE THIS BECOMES A PERMIT. Exam. 9 PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED {� l Tech.Building c4.,A �J/�� I N 180 DAYS DATEQs uED2 8 - 8 't PERMIT1N . * 4 6'0 0 O AL