1983, 06-21 Permit: 83A-5597 Plumbing FixturesPLAN NUMBER
APPLICATION/PERMIT
SPOKANE COUNTY — DEPARTMENT OF BUILDING & SAFETY
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509),456-3675
-APPLICANT: COMPLETE NUMBERED SPACES —
PRESS HARD TO MAKE 3 COPIES
STREET ADDRESS
1.
'IC2O-S f71"
PARCEL NO.
LOT
2.
O NER
lr%iJ
3.
BLOCK
SUBDIVISION
�t'L.tV i>v
PHONE
PHONE
Ocrie
LEGAL DESCRIPTION:
MAILING ADDRESS
.15 zo "�6vc a c.1F
ZIP
Actual Set Backs in Feet to:
North 'South
4.
CONTRACTOR
A4—:?i A -N
ADDRESS
DESIGNER
5.
ADDRESS
LICENSE EXPIRES
PHONE
224o't' 1g
ZIP
"r / 1 Ld A
Size of Parcel
Type Const.
Occupancy
[East West
Zone Classification
Residential ❑
Commercial 0
Spr'nklered
❑Yes ❑No ❑Req'd.
PHONE
New Const. Valuation
Remodeled Valuation
Total Bldg. Floor Area
ZIP
Main Floor
Upper Floors
Garage/Storage
Greenhouse
CHANGE OF USE FROM
6.
TO
Cover Deck
Uncv. Deck
Fin. Basement
Unfin. Basement
TYPE ❑"NEW ❑ ALT. ❑ AD' N. ❑ RPL.
7. OF
WORK 0 BLD. PiPLMB. 0 MECH. ❑ M.H.
0 MVE.
❑ POOL
❑ OTHER
No. Baths
No. Floors
No. Fin. Rooms
No. Dwellings
Certifi. of Exempt.
or Variance
Required
Received
Yes No
Yes ❑ No 7:
Number
DESCRIBE WORK
8. c( 17-71),--1 Ko_,sr
Shorelines/Flood Hazard
Yes Not Applic. ❑
Plans Required 0
Received 0
VALUATION
9.
SOURCE
UTILLIITIES
GAS
ELECTRIC
WATER
PUBLIC 0
PRIVATE ❑
SEWAGE
SEPTIC ❑
SEWER 0
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 SIDE FOR REQUIRED INSPECTIONS
SIGNATURE OF
OWNER OR AGENT
141
APPLICATION . .
DATE (' S /
SPECIAL APPROVALS
PRELIM. FINAL DATE
Env. Health
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
I
L
ib4. 'S
itf,Z , S i a tc
Sranso Pi P6
PERMIT IS NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
FEES COLLECTED
Building
Plumbing
Mech.
Plan Check
SEPA
Modular/
MFG. Home
Other (Specify)
4. .CC
TOTAL $ -4—k `o 7
PERMIT NUMBER
� — 5S`r)
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATEQS. UE[7 1 _ 8 5
PERMIT'NO. 9' 7 o
*41.00iO,rAL