1984, 03-07 Permit: 84A-1929 Plumbing FixturesPLAN NUMBER APPL ICAT ION /PERMIT PERMIT NUMBER
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
STREETADDRESS PARCEL NO.
. 117,: C I Y -t.
LOT BLOCK SUBDIVISION LEGAL DESCRIPTION:
2.
OWNER
PHONE
PHONE
;4
3.
MAILING ADDRESS
ZIP
Actual Set Backs in Feet to:
North South East
West
CO TRACTOR` LICENSE EXPIRES
kr-444",l104t_rt
PE
Size of Parcel
Zone Classification
Residential ❑
442244 JtAL �?
Commercial El
4.
A ESSZI
3 F_ f-- ,L.� i—
' 0?1
Type Const.
Occupancy
Sprinklered
11 Yes Ll No ❑Req'd.
DESIGNER
PHONE
New Const. Valuation
Remodeled Valuation
Total Bldg. Floor Area
5.
ADDRESS
ZIP
Main Floor Upper
Floors
Garage/Storage
Greenhouse
CHANGE OF USE FROM
TO
Cover Deck
Uncv. Deck
Fin. Basement
Unfin. Basement
s.
TOF YPE (�jpL€�/�/ El ALT. 11 AWN. 11 RPL. El MVE.
No. Baths No.
Floors
No. Fin. Rooms
No. Dwellings
7 ❑OTHER
WORK ❑ BLD. �PLMB. 11 MECH. El M.H. ❑ POOL
Certifi.ofExempt.
Required
Yes 171 No❑
Number
or Variance
Received
Yes 11 No❑
8 DESCRIBE WORK �� ��
Shorelines/ Flood Hazard
Plans Required El
Yes El Not Applic. ❑
Received ❑
VALUATION
9•
I SOOUFCE
GAS
ELECTRIC
PUB WATER IC ❑
SEPT C El SEWAGE
Ownership
FEES COLLECTED
UTILITIES
PRIVATE ❑
SEWER E]Public
❑ Private ❑
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 provision other state or local law regulating construction or the performance
of construction. SEE REVER E FOR REQUIRED INSPECTIONS
Plumbing
SIGNATURE OF APPLICATION
OWNER OR AGENT DATE
Mech.
SPECIAL APPROVALS
PRELIM. FINAL D
Env. Health
Planning
Fire
Prevent.
Utilities
SEPA
Plans
Exam.
Building
Tech.
SPECIAL CONDI ONS: (SEE REVERSE SIDE FOR NOTICE)
7
v PERMIT IS NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
Plan Check
SEPA
Modular/
MFG.Home
Other (Specify)
TOTAL $
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DAT nJ(� aw (� �7 1 r�
uE n / /' PERMIT 9.2 9 Z
a
d
c:
W
J
LL
*50.00
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