1984, 02-01 Permit: 84A-873 Plumbing FixturesPLAN NUMI:SLH
APL IGA-h ION / PERMIT
SPOKANE COUNTY — DEPARTMENT OF BUILDING & SAFETY
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
now
TREET ADDRESS '
1. /Y7 E. /7
LOT BLOCK SUBDIVISION
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
2.
3.
OWNER
MAILING ADDRESS
PHONE
PHONE
ZIP
PARCEL NO.
LEGAL DESCRIPTION:
Actual Set Backs in Feet to:
North (South
East West
CQTRACTOR LICENSE AXE
4
C.70 5s 4 �1 �s� ,c��c� ,. !!�a//
ADirF§S2"
PFWV-
ZIL itiY1GP
Size of Parcel
Zone Classification
Residential ❑
Commercial ❑
Type Const. Occupancy
Sprinklered
❑Yes El No ❑ Req 'd.
DESIGNER
5. ADDRESS
PHONE
ZIP
CHANGE OF USE FROM
TO
TYPE 1 NEW ❑ ALT. ❑ AD' N. ❑ RPL. ❑ MVE.
7. OFWORK ❑ BLD. �PLMB. ❑ MECH. ❑ M.H. IIPOOL ❑OTHER
New Const. Valuation I Remode ed Valuation I Total Bldg. Floor Area
Main Floor IUpper Floors Garage/Storage I Greenhouse
Cover Deck I Uncv. Deck
No. Baths
Fin. Basement I Unfin. Basement
No. Floors No. Fin. Rooms
No. Dwellings
Certifi. of Exempt.
or Variance
Required Yes❑ No
Received Yes ❑ No
Number
DESCRIBE WORK
8.
F
Shorelines/Flood Hazard
Yes ❑ Not Applic. ❑
Plans Requ'red ❑
Received ❑
VALUATION
9.
SOURCE
OF
UTILITIES
GAS
ELECTRIC
WATER
PUBLIC ❑
PRIVATE ❑
SEWAGE
SEPTIC ❑
SEWER Cl
Ownership
Public ❑ Private D
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 provis'- of - other state or local law regulating construction or the performance
of construction. SEE REVERS • FOR RE UIRED INSPECTIONS
SIGNATURE OF APPLICATION t /
OWNER OR AGENT `— ' DATE e 3.! �'
SPECIAL APPROVALS
PRELIM. FINAL DATE
Env. Health
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
SPECIAL CON r ITIONS: (SEE REVERSE SIDE FOR NOTICE)
cep
4 Tc'�
4cscs.c
� S�wrC
set(
PERMIT IS NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
FEES COLLECTED
Building L_
Plumbing 45 rec
Mech.
Plan Check
SEPA
Modular/
MFG. Home
Other (Specify)
TOTAL $
P MI NUMBER
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATEQSiUEE' 1 —8 4
PERMIT N8.7, 3 z
*45,000OTAL