1984, 01-23 Permit App: 84A-624 Mechanical FixturesPLAN 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
STREETADDRESS PARCEL NO.
1. C eel _ .2ctt
2. LOT I BLOCK I SUBDIVISION LEGAL DESCRIPTION:
OWNER ON PHONE
MAILIP ADDRESS ZIA Actual Set Backs in Feet to:
V �j}
L L
Plan Check
h South East
West
CONTR TORLIC
S XPIRES
P ONE
-
Size of Parcel
Zone Classification
Residential ❑
,
Commercial ❑
ADDRS
^
TYpeConst.
Occupancy
�r❑Nor�
.L ( i
Dyes ❑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.
No. Baths No.
Floors
No. Fin. Rooms
No. Dwellings
TYPE ❑ NEW ❑ ALT. ❑ AD' N. ❑ RPL. ❑ MVE.
% OF WORK El BLD. ❑ PLMB.VMECH. ElM.H. El POOL El OTHER
Certifi.ofExempt.
Required
Yes❑ No❑
Number
or Variance
Received
Yes❑ No❑
8 DESCRIBE WORK �� A.4
Shorelines/ Flood Hazard
Plans Required El
Yes[] Not Applic. ❑
Received ❑
VALUATION
9
I SOURCE
GAS
ELE RIC
PUBLICR❑
SEPTIC
Ownership
FEES COLLECTED
UTILITIES
PRIVATE ❑
SEWER ❑
Public O 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 resume to
p p g g p p 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 APPLICATION1
�� —
/
OWNER OR AGENT DATE ,7
Mach. !
SPECIAL APPROVALS
PRELIM. FINAL D.
Env. Health
Planning
Fire
Prevent.
Utilities
z.c.'A
SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
]
/
Plan Check
SEPA
Modular/
MFG. Home
Plans ,, PERMIT IS NONTRANSFERABLE
Exam. PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
Building IN 180 DAYS
Tech. 1 I 7_
Other (Specify)
PERMIT NUMBER
Q
TOTAL $ l
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS"BECOMESA PERMIT.
DATE" fb2 3— 8 4 PERMIT J 2' 4 z
* 19.0 O fOi-AL
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W
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