1984, 04-12 Permit: 84A-3277 Plumbing FixturesPLAN NUMBER
APPLICATION/PERMIT
SPOKANE COUNTY —ARTMENT OF BUILDING & SAFETY
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 3 COPIES
1.
2.
STREET ADDRESS
1470' I`
LOT
BLOCK
PARCEL NO.
SUBDIVISION
3.
OWNER
PHONE
PHONE
LEGAL DESCRIPTION:
MAILING ADDRESS
ZIP
4.
A RESS
A z� . iCoYua i
CONmc0
LICENSE EXPIRES
's- 33
Actual Set Backs in Feet to:
North 'South East ( West
Size of Parcel 1 Zone Classification
Residential ❑
Commercial ❑
9P0
ZIP
°Ig2(('
Type Const.
Occupancy
Spr'nklered
❑Yes ❑No ❑Req'd.
5.
DESIGNER
PHONE
New Const. Valuation
Remodeled Valuation
Total Bldg. Floor Area
ADDRESS
ZIP
Main Floor
Upper Floors
Garage/Storage
Greenhouse
6.
CHANGE OF USE FROM
TO
Cover Deck
Uncv. Deck
Fin. Basement
Unfin. Basement
7. TYPEOF ' NEW ❑ ALT. ❑ AD'N. ❑ RPL. E MVE. ❑OTHER
WORK ❑ BLD. A.PLMB. ❑ MECH. ❑ M.H. ❑ POOL
No. Baths
No. Floors
No. Fin. Rooms
No. Dwellings
Certifi. of Exempt.
or Variance
Required Yes❑ No CI
Received Yes❑ Nor]
Number
DESCRIBE WORK
Shorelines/Flood Hazard
Yes❑ Not Applic. ❑
Plans Required ❑
Received ❑
VALUATION
9.
SOURCE
OF
UTILITIES
GAS
ELECTRIC
WATER
PUBLIC ❑
PRIVATE ❑
SEWAGE
SEPTIC ❑
SEWER ❑
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 specif'= • -rein or not. The granting of a permit does not presume to give au-
thority to violate or cancel the provision of any o her state or local law regulating construction or the performance
of construction. SEE REVERS - DE F S R REQUI ED INSPECTIONS
SIGNATURE OF /1 APPLICATION 4r-'! —!i
OWNER OR AGENT DATE
SPECIAL APPROVALS SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PRELIM. FINAL DATE
Env. Health
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
9l•
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)
f
L i3v
TOTAL $ '
PERMIT NUMBER
F11 F f:f1PY
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATEVSAUED1 2 8 4
PERMIT12. 7.7 z *5 OA 0 IOIAL