1984, 03-22 Permit: 84A-2467 Plumbing FixturesPLAN NUMBER APPLI(CATlON,, 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 STR ETADDREs�si � a, � 7` PARCEL NO.
LOT BLOCK SUBDIVISION LEGAL DESCRIPTION:
2.
3. 1' 7 .w
MAI G DDR 6S
w
TRA TJ�R
4. ADD%Z2v L� 2
DESIGNER
5. ADDRESS
CHANGE OF USE FROM
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PHONE
ZIP
TYPE NEW ❑ ALT ❑ AWN. ❑ RPL. ❑ MVE.
PERMIT NUMBE
Actual Set Backs in Feet to:
Certifi.ofExempt.
or variance
North South East West
Yes❑ No❑
Yes❑ No❑
SizeofParcel
Zone Classification
Residential
Commercial ❑
Const.
Occupancy
Sprinklered
❑Yes ❑No ❑Req'd.
Plans Required ❑
8. DESCRIBE WORK
Yes❑ Not Applic. ❑
Const. Valuation
j
Remodeled Valuation
Total Bldg. Floor AreaUOn
SOURCE
GAS
ELECTRIC
WATER
PUBLIC ❑
Floor
Upper Floors
Garage/Storage
Greenhouse
Cover Deck
Uncv. Deck
Fin. Basement
Unfin. Basement
PRIVATE ❑
SEWER ❑
No. Baths
No. Floors
No. Fin. Rooms
No. Dwellings
reverse side, and know the same to be true and correct. All provisions of laws and ordinances governing this type of
Building
will be complied with whether specified herein or not. The granting of a permit does not presume to give au-
7. OF ❑ OTHER
❑ BLD. ❑ PLMB. ❑ MECH. ❑ M.H. ❑POOL
Certifi.ofExempt.
or variance
Required
Received
Yes❑ No❑
Yes❑ No❑
Number
WORK
Shorelines/ Flood Hazard
Plans Required ❑
8. DESCRIBE WORK
Yes❑ Not Applic. ❑
Received ❑
VALUATION
SOURCE
GAS
ELECTRIC
WATER
PUBLIC ❑
SEWAGE
SEPTIC ❑
Ownership
public ❑Private ❑
FEES COLLECTED
9.
UTILOITIES
PRIVATE ❑
SEWER ❑
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
Building
will be complied with whether specified herein or not. The granting of a permit does not presume to give au-
work
thority to violate or cancel the provisions of any other state or local law regulating construction or the performance
Plumbing
of construction. SEE REVERSE SIDE FOR RE�INSECTIONS
APPLICATION
SIGNATURE OF ..�
Mech.
DATE
OWNER OR AGENT
SPECIAL APPROV7Ld
SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
Plan Check
PRELIM. FINAL DATE
f o /
Env. Health
SEPA
_ s),owey,
Planning
/
7— S
Modular/
MFG. Home
i
revent.
Prelk
,_ ��/ j j /
/',
Other (Specify) X
Engineer
_ !� c `
I r� `
S ,O
utilities
TOTAL $
SEPA
l
1 —�
WHEN MACHINE VALIDATED IN THIS SPACE,
PERMIT IS NONTRANSFERABLE
THIS BECOMES A PERMIT.
Plans
Exam.
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
_
– 4 7 z
Building
ID 1 0 DAYS
IssUED PERMIT NO.
DATE ISSUED
Tech.
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*54.00°
ij-
TOTAL