1983, 12-13 Permit: 83B-2475 Hot Water Tank_..,.nUMBER APPLICATION/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 �,j t?ARCL�N NO.
�. �—"� .�
LOT BLOCK SUBDIVISION LEGAL DESCRIPTION:
2.
OWNER 15PH NE PHONE
3 a..
MAILING RE kZI
Actual Set Backs in Feet to:
North South East
I West
CONTRACTORLICENSE
EXPIRE
PHONE
Size of Parcel
Zone Classification
Residential ❑
%—jf
Commercial ❑
ADDRESS
Z
Type Const. Occupancy
Sprinklered
❑Yes ❑No ❑Req'd.
a
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.
No. Baths No.
Floors
No. Fin. Rooms
No. Dwellings
TYPE El NEW El ALT. ❑ AD'N. El RPL. El MVE.
❑OTHER
WORK El BLD. 11PLMB. ElMECH. 1:1M.H. El POOL
Certifi.ofExempt.
Required
Yes❑ No❑
Number
or Variance
Received
Yes ❑ No ❑
DESCRIBE WORK
01A(,%��
Shorelines/ Flood Hazard
Plans Required ❑
8•
Yes❑ Not Applic. ❑
Received ❑
VALUATION I
SOURCE
OF
r GAS1�LECTRIC
I WATER
PUBLIC ❑
SEWAGE
SEPTIC El
Ownership
FEES COLLECTED
9
UTILITIES
PRIVATE ElSEWER
El
public ❑Private ❑
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
work will be compiled 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 REVERSES OR REQUIRED INSPECTIONS
Plumbing
SIGNATURE OF % APPLICATION 1Z _ 7_,��
DATE
' /_ 00
Mach.
OWNER OR AGENT
SPECIAL APPROVALS
SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
Plan Check
PRELIM. FINAL DATE
Env. Health
i
/ (/ (/L J
SEPA
Planning
Modular/
MFG. Home
Prevent.
Engineer
Utilities
SEPA
Plans PERMIT IS NONTRANSFERABLE
Exam. PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
Building 1�/, IN 180 DAYS
Tech.
Other (Specify)
PERMIT NUMBER
x.38 - z
I�
TOTAL $ I
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT. 7 nn
DATE 13S�6.1 5 PERMIT 1 6 7. 5 z *16.0 OTO
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