1984, 02-06 Permit: 84A-1021 Mechanical Fixtures�►rrLIcATIL N/PERMIT
SPOKANE COUNTY — DEPARTMENT OF BUILDING & SAFETY
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
STREET ADDRESS
1.
LOT
2.
APPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 3 COPIES
BLOCK
/i7/%c' /q)4 --
SUBDIVISION
PARCEL NO.
OWN�7�,� '
3 Dr?? / 7'7� 5(d 0, /1-C.0.-/
MAILING ADDRESS
5.
6.
PHONE
PHONE
LEGAL DESCRIPTION:
CONTR4CTOi
ADDRESS
/%29 SS.
DESIGNER
ADDRESS
ZIP
LICENSE EXPIRES
_ /t
PH_ONE
.53.5-- 7332
Actual Set Backs in Feet to:
North 'South
Size of Parcel
East I West
Zone Classification
Residential G
Commercial ❑
ZIP ,
Type Const.
Occupancy
Sprinklered
DYes No GReq 'd.
PHONE
New Const. Valuation
Remode ed Valuation
Total Bldg. Floor Area
CHANGE OF USE FROM
ZIP
Main Floor
Upper Floors
Garage/Storage
Greenhouse
TO
Cover Deck
Uncv. Deck
Fin. Basement
Unfin. Basement
TYPE fl -NEW ❑ ALT. ❑ AD' N. ❑ RPL. ❑ MVE.
7. OF ❑ OTHER
WORK ElBLD. ❑ PLMB. IDMECH. ❑ M.H. ❑ POOL
DESCRIBE WORK ;
./
8t, 6.74- '/C du c rSyS "-Pin
VALUATION SOURCE GAS f EL CTRIC WATER
9'
UTILITIES PRIVATEPUBLIC 7
❑
No. Baths
No. Floors
No. Fin. Rooms
No. Dwellings
Certifi. of Exempt.
or Variance
Required Yes D No
Received Yes❑ No❑
Number
Shorelines/Flood Hazard
Yes Not Applic.
Plans Required ❑
Received O
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 FQR REQUIRED INSPECTIONS
SIGNATURE OF
OWNER OR AGENT
G'l
SPECIAL APPROVALS
PRELIM. FINAL DATE
DATE APPLICATION
Env. Health
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
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)
-)/) vC
TOTAL $ r
PERMIT NUMBER
4A - to 2-1
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
ff 11 }} ((1�
DATE FSSUEDU 6
PERMIT#U 2.1 z
* 2 O. 0 0 >°D11 AL