1983, 06-13 Permit: 83A-5184 Plumbing FixturesPLAN NUMBER APPLICATION/PERMIT PERMIT NUMBER
I SPOKANE COUNTY - DEPARTMENT, OF BUILDING & SAFETY
NORTH 811 JEFFERSON/ SPOKANE, WASHINZ°.,TON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
STREET ADDRESS PARCEL NO.
2.
LOr BLOCK SUBDIVISION LEGAL DESCRIPTION:
OWNER PHONE PHONE
_ r i
3. MAILINGADDRES19 I ZIP Actual Set Backs In Feet to:
` A a K
71 r%r4✓61--
North South East West
C - OARACThR
LICENSE PIRES
PHONE
Size of Parcel
Zone Classification
Residential ❑
`o 1
V
Commercial ❑
A. o
DRESS
ZIP
Type Const.
Occupancy
Sprinklered
Q /1
OYes ❑No ❑Req Id.
L
DESIGNER
PHONE
New Const. Valuation
Remodeled Valuation
Total Bldg. Floor Area
�J.
ADDRESS
ZIP
Main Floor Upper
Floors Garage/Storage
Greenhouse
U3* *65.00
CHANGE OF USE FROM
TO
Cover Deck
Uncv. Deck
Fin. Basement
Unfin. Basement
6.
*65.00
No. Baths No.
Floors
No. Fin. Rooms
No. Dwellings
A
TYPE XLVEW ❑ ALT. ❑ AWN. ❑ RPL. ❑ MVE.
7. OF
El BLD. KPLMB. ElMECH. ElM.H. El POOL ❑OTHER
J j 8 z
Certifi.ofExempt.
Required Yes El No❑
Number
WORK
or Variance
Received Yes[] No❑
L-
DESCRIBE WORK
Shorelines/ Flood Hazard
Plans Required ❑
8• ! b
r'
Yes[] Not Applic. O
Received ❑
G 4 7
VALUATION
SOOUFCE
GAS ELECTRIC
PUBLIC O
SEPT CG❑E
Ownership
FEES COLLECTED
9•
UTILITIES
PRIVATE ❑
I SEWER ❑
Public ❑ Private ❑
1 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 herein or not. The granting of a permit does not presume to give au-
Awherpecified
thority to violate or cancel ons of any er st a or local law regulating construction or the performance�of
construction. SEE REVEFOR R UI D I PECTIONS
Plumbing sem_
SIGNATURE OFAPPLICATION ��''
Z,
OWNER OR AGENT DATE
Mech.
SPECIAL
APPROV LS
SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PRELIM. FiNA
ATE-'--
/ a /L� I /
Plan Check
Env. Health
)� 6�,atLw-S ) raj: # TiL
! "
SEPA
Planning
Modular/
` i�%�
MFG. Home
+ C,
a
Fire
Prevent.
ii
1 ' l7i �Ct-w�S ke r
!!�1 //
Other er (Specify)
C
t,
-` A
U.
Utilities
TOTAL $
SEPA
PERMIT IS NONTRANSFERABLE
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
Plans
Exam.
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
/�' 13-8)
3 — 8.3
Building
Tech.
'
DATE IQStlED'1
IQPERMIT 501 8,425 *65,O OT® 9L