1983, 09-22 Permit: 83A-9366 Mechanical FixturesPLAN NUMBER APPL ICAT ION /PERMIT
SPOKANE COUNTY - DEPARTMENT OF BUILDING & SAFETY
�1 NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 3 COPIES
STREETADDRESS PARCEL NO.
,. Z - ////q--1;2- �_t
2. LOT BL7 SUBDIVISION LEGAL ESCRIPTION:
���� � PHONE � � 79 PHONE
3. l - -
4.
EXPIRES
North I South I East I West
iassmcar�on I Residential ❑
Commercial ❑
Sprinklered
❑Yes ❑No ❑Req'd.
DESIGNER U/ 6.' PHONE z New Const. Valuation Remodeled Valuation I Total Blda. Floor Area
5.
ADDRESS ZIPMain Floor Upper Floors Garage/ Storage
CHANGE OF USE FROM TO Cover Deck Uncv. Deck Fin. Baseme
6.
No. Baths No. Floors No. Fin. Roorr
7
TYPE ❑ NEW El ALT. 11AD' N. El RPL. ElMVE. ❑OTHER
WORK ❑ BLD. ❑ PLMB. MMECH.
❑ M.H. ❑ POOL
Certifi. of Exempt.
Required
Yes❑ No❑
Number
or Variance
Received
Yes❑ No❑
DES RIB
8.
� PSLA-,/
Shorelines/ Flood Hazard
Plans Required ❑
z
Yes Not Applic. ❑
Received ❑
VALUATION
I SOURCE
OF I
GA
ELECTRIC
I
I WATER
PUBLIC ❑
I SEWAQrE
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 SIDE FOR REOUIR D INSPECTIONS Plumbing
SIGNATURE OF APPLICATIOf�!/�, /� AT OR AGENT DATE �� / `"�__3 Mech. AT0
SPECIAL APPROVALS SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PRELIM. FINAL DATE Plan Check
Env. Health
SEPA
Planning Modular/
MFG. Home
Other (Specify)
PERMIT NUMBER
r
Utilities
TOTAL $
SEPA
MACHINE
Plans PERMIT IS NONTRANSFERABLE HEIS BECOMES A PERMITTED IN THIS SP.
AC
Exam. PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
Building IN 180 DAYSp o 0 6 b
Tech. d9-22-3
DATE ISSUED PERMIT NO.
*19,00°
TOTAL
CL
O
C.3
W
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