1983, 09-28 Permit: 83A-9710 Plumbing FixturesPLAN NUMBER
APPLICATION/PERMIT
SPOKANE COUNTY — BUILDING CODES DEPARTMENT
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
JOB ADDRESS
14911 E. 17th.
LEGAL DESCRIPTION — SEE ATTACHED
LOT
2.
BLOCK
SUBDIVISION
OWNER
3 Dean & MPredi th Hendrik
ADDRESS
E. 14911 17th_ Veradale, Wa.
CONTRACTOR
Servisoft Systems
4.
PHONE
928-0283
ZI P
99037
PARCEL NUMBER/S
Actual Set Backs in Feet
North 'South East (West
PHONE
328-6651
Size of Parcel 1 Zone Classification
ADDRESS
507 W. Indiana - Spokane
DESIGNER
5' ADDRESS
ZI P
99205
PHONE
Type Const.
Occupancy
Sprinklered
Elves ❑No ❑ Req'd.
Valuation (Building Area in Sq. Ft.
ZI P
Main Floor
Upper Floors 1 Garage Area
Storage
CHANGE OF USE FROM
6.
TYPE
7. OF
WORK
TO
Area of Decks
Finished Basement
Unfin. Basement
❑ NEW ❑ ALT. ❑ AD'N. 0 RPL. 0 MVE.
❑ BLD. KXPLMB. 0 MECH. 0 M.H. ❑ POOL
0 OTHER
No. Baths
No. Stories
No. Rooms
No. of Dwellings
CERTIFICATE
of EXEMPTION
Req'd.
Rec'd.
Not Req'd.
DESCRIBE WORK
8. Soft water installation
Enum. Dist.
ILocation (Area)
VALUATION
9.
SOURCE
OF
UTILITIES
GAS
ELECTRIC
WATER
SEWER
Ownership
Public ❑ Private ❑
USE CODE
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 authority 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 INSPECTION
DATE OF APPLICATION
5 SIGNATURE OF APPLICANT
SPECIAL APPROVALS
NAME DATE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
ng Techni
SPECIAL CONDITIONS:
PERMIT IS NONTRANSFERABLE
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
$5,00
$5.00
TOTAL $
PERMIT NUMBER
-r 7 to
uJ* '*500
*,5008
A *0.00
97098
09-29-83
g 6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
09=29-83
971,0'z *5.00a�
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE DATE ISSUED PERMIT NO. TOTAL
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