1983, 10-10 Permit: 83B-170 Mechanical FixturesPLAN NUMBER
APPLICATION/PERMIT
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
1.
2.
STREET ADDRESS
s �i�
LOT
BL CK
1'? "0
PARCEL NO.
SUBDIVISION
3
OWNER
L9 N1
PHONE
PHONE
LEGAL DESCRIPTION:
MAILING ADDRESS
ZIP
Actual Set Backs in Feet to:
North 'South ( East l West
CONTRACTOR
FsP�I S } I—i-
4. AD RESS
( RESS KIJA kJ /kuc'
LICENSE EXPIRES
D- I7
Size of Parcel
Zone Classification
Residential ❑
Commercial
Type Const.
Occupancy
Sprinklered
❑Yes ❑No ❑Req'd.
5.
DESIGNER
P ONE
New Const. Valuation
Remodeled Valuation
Total Bldg. Floor Area
ADDRESS
ZIP
Main Floor
Upper Floors
Garage/Storage
Greenhouse
CHANGE OF USE FROM
6.
TO
Cover Deck
Uncv. Deck
Fin. Basement
Unfin. Basement
TYPE Pf NEW ❑ ALT. ❑ AD' N. ❑ RPL.
7. OF /
WORK ❑ BLD. ❑ PLMB.,P MECH. ❑ M.H.
❑ MVE.
❑ POOL
❑ OTHER
No. Baths
No. Floors
No. Fin. Rooms
No. Dwellings
Certifi. of Exempt.
or Variance
Required Yes❑ No
Received Yes LI? No
Number
8.ri
DESCPIBE WORK
9.
VALUATION SOURCE
UTILITIES
GAS
ELECTRIC
WATER
PUBLIC ❑
PRIVATE ❑
SEWAGE
SEPTIC ❑
SEWER ❑
Shorelines/Flood Hazard
Yes Not Applic. ❑
Ownership
Public ❑ Private ❑
Plans Required ❑
Received ❑
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 canc the provisions of any other state or local law regulating construction or the performance
of construction. SEE R RSE SIDE FOF REQUIRE INSPECTIONS
SIGNATURE OF APPLICATION / 0
OWNER OR AGENT 5 ' /ft4fr\
DATE O_!
SPECIAL APPROVALS SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PRELIM. FINAL DATE
Env. Health
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
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)
TOTAL $
PERMIT NUMBER
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATE ISSUED 1 0 — 8 3
1 7o
PERMIT NO.1 1. 0 2
*19.0urt.