1983, 10-25 Permit: 83B-827 Plumbing FixturesPLAN NUMBER APPLICATION/PERMIT
SPOKANE COUNTY - DEPARTMENT OF BUILDING & SAFETY
NORTH 811 JEFFERSON / SPOKANE, WASHif'GTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES -PRESS HARD TO MAKE 3 COPIES
STREET ADDRESS PARCEL NO.
LOT I BLOCK SUBDIVISION LEGAL DESCRIPTION:
2.
OWNER PHONE PHONE
3. �v `- G'I d 0 "_-*�O" D Z
MAILING ADDRESS + ' ZIP Actual Set Backs in Feet to:
1 �7_..0C 10 1 Q North South East West
CONTR CT OR LICENSE EXPIRES PH NE Size of Parcel Zone Classification Residential ❑
Commercial ❑
4. ADDRESS ZIP Type Const. Occupancy Sprinklered
El Yes 11 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
6.
TYPE C�7"N"EW El ALT. ❑ AD'N. 11 RPL. ❑ MVE. No. Baths No. Floors No. Fin. Rooms No. Dwellings
7. OF� ❑ OTHER
El BLD. ZPLMB. El MECH. El M.H. El, POOL Certifi. of Exempt.
Required Yes❑ No❑ Number
WORK
or Variance Received Yes❑ No❑
DESCRIBE W9RK Shorelines/ Flood Hazard Plans Required
8• L1 ;C,' ��X—id Yes❑ NotApplic. ❑ Received ❑
VALUATION I SOURCE GAS ELECTRIC WATER SEWAGE Ownership FEES COLLECTED
9 OF PUBLIC ❑ SEPTIC ❑ Public ❑Private ❑
UTILITIES 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
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 i( r
of construction. SEE REVERSE S DE FOR REQUIRED INSPECTIONS Plumbing
SIGNATURE OF �' �- APPLICATION >,, , �/
OWNER OR AGENT DATE _I! v -?::1 1 _ Mech.
SPECIAL APPROVALS SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PRELIM. FINAL DATE 3
Env. Health z
Planning
Fire IVj
�
Prevent.
Engineer
Utilities
Plans i i I I PERMIT IS NONTRANSFERABLE
Exam. PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
Tech mg ic)/ A IN 180 DAYS
Plan Check
SEPA
Modular/
MFG. Home
Other (Specify)
TOTAL $
PERMIT NBER
UM
r, - �
WHEN MACHINE VALIDATED IN THIS SPACE,
THISBECOMESA PERMIT. QQ
DATEISSUED2 5 PERMIT NO! z
*45.00'DOD 4L
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