1983, 12-27 Permit: 83B-2780 Plumbing FixturesPLAN NUMBER APPLIICATION /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
1. /> 'L) c- �r 1
PARCEL NO.
LOT
BLOCK
SUBDIVISION
LEGAL DESCRIPTION:
2.
Engineer
OWNER
3. -'�' ) 1
PIJONE
1 T4
PHONE
MAILING ADDRESS
ZIPIActual
Set Backs in Feet to:
TYPE KINEW ElALT. ElAD'N. ElRPL. ElMVE.
North South East West
CONTRACTOR
LICENSE EXPIRES
HO ESize
of Parcel
Zone Classification
Residential ❑
4. v
;�/
L i
Received
Yes❑ No❑
Commercial ❑
ADSD,RE
ZI�
Type Const.
Occupancy
SprinkleredeC-
it ��
57
SOURCE
GAS
❑Yes ❑No ❑Req'd.
DESIGNER
PH ENew
Const. Valuation
Remodeled Valuation
Total Bldg. Floor Area
9•
I UTILITIES
I PRIVATE ❑
5. ADDRESS
ZIP
Main Floor
Upper Floors
Garage/Storage
Greenhouse
CHANGE OF USE FROM
TO
Cover Deck
Uncv. Deck
Fin. Basement
Unfin. Basement
s.
Engineer
No. Baths No.
Floors
No. Fin. Rooms
No. Dwellings
TYPE KINEW ElALT. ElAD'N. ElRPL. ElMVE.
Plans
Exam.
j OF ❑ OTHER
❑BLD. �MB. ❑ MECH. ❑ M.H. ❑POOL
avariance empt.
Required
YesNo❑
Number
WORK
;�/
L i
Received
Yes❑ No❑
DESCRIBE WOR
Shorelines/ Flood Hazard
Plans Required El8.
I=� ���
Yes❑ Not Applic. ❑
Received El
VALUATION
SOURCE
GAS
ELECTRIC
PUBLIC O
SEWAGE
Ownership
FEES COLLECTED
9•
I UTILITIES
I PRIVATE ❑
SEWER ❑
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
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
1.,
of construction. SEEREVERSE SID OR EO I SPECTIONS
Plumbing Cf%�
SIGNATURE OF"'` APPLICATION -� - ����"
®� G -
Mach.
OWNER OR AGENT DATE r_
SPECIAL APPROVALS
SPECIAL CO IONS: (SEE REVERSE SIDE FOR NOTICE)
Plan Check
PRELIM. FINAL DATE
Env. Health
i
SEPA
Planning
—1-72
Modular/
MFG.Home
Other (Specify)
PERMIT NUMBER''f
C ( b0
TOTAL $ I
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
x
DATE UgD2 _ R / * 6 9
PERMIT�O. 8' 0 z ' U d fO+AL
t✓
PERMIT IS NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
;�/
L i
MFG.Home
Other (Specify)
PERMIT NUMBER''f
C ( b0
TOTAL $ I
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
x
DATE UgD2 _ R / * 6 9
PERMIT�O. 8' 0 z ' U d fO+AL