1984, 02-15 Permit: 84A-1276 Plumbing FixturesPLAN NUMBER APPL ICAT ION /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
STREET ADDRESS
PARCEL NO.
1. /20o( E-
,
LOT
OCIVISION
BLK
SUBD
LEGAL DESCRIPTION:
2.
I
7. OF ❑ OTHER
❑ BLD. XPLMB. ❑ MECH. ❑ M.H. ❑ POOL
OWNER
PHONE
PHONE
kof 5 e__03
Exempt.
Required Yes El No❑
Number
WORK
oCrVarian
Received Yes❑ No[]
MAILING ADDRESS
Zip
Actual Set Backs in Feet to:
Shorelines/ Flood Hazard
Plans Required ❑
North South East West
CO TRACTOR
LICENSE EXPIRES
PHONE
Size of Parcel
Zone Classification
Residential ❑
_
4'
23- Or
e707 V_
Ownership
Commercial ❑
g13�3
Z�o2
Type Const.
Occupancy
Sprinklered
3
' s !
Public ❑ Private ❑
❑Yes ❑No ❑Req'd.
DESIGNER
PHONE
New Const. Valuation
Remodeled Valuation
Total Bldg. Floor Area
5.
thority to violate or cancel the provisions of any other state or local law regulating construction or the performance
ADDRESS
ZIP
Main Floor
Upper Floors
Garage/Storage
Greenhouse
CHANGE OF USE FROM TO Cover Deck Uncv. Deck Fin. Basement Unfin. Basement
s.
PERMIT NUMBER
DC7
eL.
O
V
W
J
LL
No. Baths
No. Floors
No. Fin. Rooms
No. Dwellings
TYPE <N EW ❑ ALT. ❑ AD' N. ❑ RPL. ❑ MVE.
7. OF ❑ OTHER
❑ BLD. XPLMB. ❑ MECH. ❑ M.H. ❑ POOL
Exempt.
Required Yes El No❑
Number
WORK
oCrVarian
Received Yes❑ No[]
DESCRIBE WORK D
Shorelines/ Flood Hazard
Plans Required ❑
8.
Yes❑ Not Applic. ❑
Received ❑
VALUATION
SOURCE
GAS
ELECTRIC
WATER
PUBLIC ❑
SEWAGE
SEPTIC ❑
Ownership
FEES COLLECTED
9.
UTILITIES
PRIVATE ❑
SEWER ❑
Public ❑ Private ❑
1 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
Building
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 provisions of any other state or local law regulating construction or the performance
of construction. SEE REVERSE SID R REOUIRED INSPECTIONS
Plumbing
SIGNATURE OF APPLICATION a .{S�
OWNER OR AGENT DATE /
Mach.
SPECIAL
APPROVALS
SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
Plan Check
PRELIM. FINAL
DATE
�2 !t.)&
Env. Health
VL'f s
' lz%j
SEPA
Modular/
Planning
/ 56.Cxrn
MFG. Home
Fire
Prevent.
( wk} Srd
F//
Other (Specify)
C'l.'
Engineer
Utilities
I
I �/`�
TOTAL $
SEPA
WHEN MACHINE VALIDATED IN
THIS SPACE,
Plans
PERMIT IS NONTRANSFERABLE
THIS BECOMES A PERMIT.
Exam.
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
Building
Tech.1
A�tf
IN 180 DAYS
j 7 U 4
DATEF53tJED ppPERMIT1
r
j l L
0 7. 6 z 5 O O 13OtAL
eL.
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W
J
LL