1984, 02-16 Permit: 84A-1323 Gas FixturesPLAN NUMBER I AF'F'L K;A 1 IUN / F'tRM 1 1
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 PARCEL NO.
,. If ail-- -M
TYPE ❑NEW
OF
WORK ❑ BLD.
11 ALT. El AD'N. E) RPL.
❑ PLMB.r4MECH. ❑ M.H.
1:1 MVE.
❑ OTHER
❑ POOL
No. Baths
LOT
BLOCK
SUBDIVISION
Certif(.ofExempt.
or Variance
Required Yes❑ No❑
Received Ye;❑ No❑
LEGAL DESCRIPTION:
8•
2.
(xN•-��
I
OWNER OR AGENT DATE 11 7rQD
ore nes Hazard
yes Not Applic. ❑
1
Plans Required ❑
Received ❑
9•
OWNER
PH�IE
PHONE
3.�
PUBLIC 0
PRIVATE 0
SEPTIC O
SEWER ❑
Ownership
Public ❑ Private ❑
MAILING ADDRESS V
ZIP
Actua Set Backs in Feet to:
SEPA
— 1 7 tit
Planning
North South
East West
CONTRACTOR ,
LIC NS EXPIRES
LHON/
size ofParcel
Zone Classification
Comdmercial❑❑
`(S (.4 .IW-t��i. (
4.
ry J`( O C,
MFG. Home
>_
ADDRESSC
Type Const.
Occupancy
Spr❑Nor�
r o
c!
r „ r�
Other (Specify)(��'�""
QrLn�•
C
v
LL_
❑Yes ❑Req'd.
DESIGNER
PHONE
New Const. Valuation
Remodeled Valuation
Total Bldg. Floor Area
5.
ci:,
LL
Utilities
ADDRESS
ZIP
Main Floor
Upper Floors
Garage/Storage
Greenhouse
CHANGE OF USE FROM TO Cover Deck Uncv. Deck Fin. Basement Unfin. Basement
IJ.
7.
TYPE ❑NEW
OF
WORK ❑ BLD.
11 ALT. El AD'N. E) RPL.
❑ PLMB.r4MECH. ❑ M.H.
1:1 MVE.
❑ OTHER
❑ POOL
No. Baths
No. Floors
No. Fin. Rooms
No. Dwellings
Certif(.ofExempt.
or Variance
Required Yes❑ No❑
Received Ye;❑ No❑
Number
8•
DESCRIBE WO 1
(xN•-��
OWNER OR AGENT DATE 11 7rQD
ore nes Hazard
yes Not Applic. ❑
1
Plans Required ❑
Received ❑
9•
VALUATION
I SOURCE(/
UTILITIES
GAS
X
ELECTRIC
PUBLIC 0
PRIVATE 0
SEPTIC O
SEWER ❑
Ownership
Public ❑ Private ❑
FEES COLLECTED
I hereby certify that I have read and examined this application and have read the "NOTICE" provisions included on
reverse s'de and L the same t be tr d o + All o f 1 d d' th' t f
PERMIT NUMBER
94A - . 0 z
04* *20.00
*2000'
A *000
1322
02-16-84
6479.
l , w o ue an c r pr Visions o aws an or lnances governing is ype o
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
of construction. SEE REVERSE SIDE FOR REOUIRED INSPECTIONS
Plumbing
SIGNATURE OF_
j 'C�
OWNER OR AGENT DATE 11 7rQD
Mech.
Plan Check
SPECIAL
APPROVALS
PRELIM.
FINAL
DATE
SPECIAL CONDITIONS- (SEE REVERSE SIDE FOR NOTICE)
Env. Health
SEPA
Planning
Modular/
MFG. Home
>_
Fire
Prevent.
r „ r�
Other (Specify)(��'�""
QrLn�•
C
v
LL_
Engineer
ci:,
LL
Utilities
\
TOTAL $'
SEPA
PERMIT IS NONTRANSFERABLE
WHEN MACHINE VALIDATED IN
THIS BECOMES A PERMIT.
THIS SPACE,
Plans
Exam.
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
(� .
6 — 4
2, 3 0 * 2 O. 0 0
Building
Tech.
/f '
/ ,
✓
�/
DATALiDI PERMITW
1010tAL