1984, 02-03 Permit: 84A-954 Water Heater, PipingPLAN NUMBER APPL ICAT ION /PERMIT
SPOKANE COUNTY - DEPARTMENT OF BUILDING & SAFETY
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
CHANGE OF USE FROM
TO
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
Uncv. Deck
STREET ADDRESS
6.
PARCEL NO.
1
No. Baths No.
Floors
No. Fin. Rooms
No. Dwellings
TYPE NEW ❑ALT. El AWN. ❑RPL. El MVE.
LOT BLOCKSUBDIVISION
LEGAL DESCRIPTION:
2.
WORK El BLD. El PLM B. PLM ECH. ❑ M. H. El POOL
OWNER ,
�
PHONE
i N —61-1,
Nl 61 � 1
3.
or Variance
Received
Yes ❑ No ❑
8 DESCRIBE WORK
M �
AILING ADDRESS
Plans Required 0
ZIP
Actualt Backs in Feet to:
Received ❑
—
'
GAS
North South East West
PUBLIC 11
CONTRACTOR
Ownership
LICENSE EXPIRES
PHONE
Size of Parcel
Zone Classification
Residential❑
4.
PRIVATE ❑
SEWER ❑
Public ❑ Private ❑
1 hereby certify that I have read and examined this application and have read the "NOTICE" provisions included on
Commercial ❑
reverse side, and know the same to be true and correct. All provisions of laws and ordinances governing this type of
ADDRESS
work will be complied with whether specified herein or not. The granting of a permit does not presume to give au-
ZIP
Type Const.
Occupancy
Sprinklered
Plumbing
SIGNATURE OF- APPLICATION G
—� _o
Mach.20, i
OWNER OR AGENT DATE h�
SPECIAL APPROVALS
❑Yes ❑No ❑Req'd.
DESIGNER
PHONE
New Const. Valuation
Remodeled Valuation T
otal Bldg. Floor Area
5.
ADDRESS
Planning
ZIP
Main Floor
Upper Floors
Garage/Storage
Greenhouse
CHANGE OF USE FROM
TO
Cover Deck
Uncv. Deck
Fin. Basement
Unfin. Basement
6.
No. Baths No.
Floors
No. Fin. Rooms
No. Dwellings
TYPE NEW ❑ALT. El AWN. ❑RPL. El MVE.
7 OF El OTHER
WORK El BLD. El PLM B. PLM ECH. ❑ M. H. El POOL
Certifi. of Exempt.
Required
Yes❑ No❑
Number
or Variance
Received
Yes ❑ No ❑
8 DESCRIBE WORK
M �
Shorelines/
l
Plans Required 0
`
YesENotApplazic.ar❑d
Received ❑
VALUATION
9•
SOURCE
GAS
ELECTRIC
PUBLIC 11
SPTTISEWAGE
Ownership
FEES COLLECTED
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
work will be complied with whether specified herein or not. The granting of a permit does not presume to give au-
Building
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 REQUIRED INSPECTIONS
Plumbing
SIGNATURE OF- APPLICATION G
—� _o
Mach.20, i
OWNER OR AGENT DATE h�
SPECIAL APPROVALS
SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PRELIM. FINAL DATE
Plan Check
Env. Health
SEPA
Planning
Modular/
MFG. Home
Fire
Prevent.
Utilities
Plans PERMIT IS NONTRANSFERABLE
Exam. PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
Building IN 180 DAYS
Tech. �_ ,
Other (Specify)
TOTAL $ G611_
WHEN MACHINE VALIDATED IN
THIS BECOMES A PERMIT.
n
PERMITNUMBER
H
�OtAL
DATE FS9UEDo n' PERMIT Nd.' 7, 4 z * 2 (i, 0 U
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