1983, 04-21 Permit: 83A-3284 Plumbing FixturesPLAN NUMBER APPLICATION/PERMIT F` � PERMI NUMBER
SPOKANE COUNTY — DEPARTMENT OF BUILDING & SAFETY c� c
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
Tech mg Y IN 180 DAYS DATE FS %- 2 5 — 8 PERMIT �' z * 61. 0 11011 -AL
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APPLICANT: COMPLETE NUMBERED SPACES -PRESS HARD TO MAKE 3 COPIES
No. Floors
STREET ADDRESS
No. Dwellings
PARCEL NO.
_.
C
7. OF ❑ OTHER
❑ BLD. *-PLMB. ❑ MECH. ❑ M.H. ❑ POOL
LOT
BLOCK
SUBDIVISION
LEGAL DESCRIPTION:
2.
Number
WORK
or Variance
Received Yes ❑ No ❑
DESCRIBE WORK
O NER
Plans Required ❑
PHONE
PHONE
Yes Not Applic. ❑
3.
�.
VALUATION
I SOURCE
OF
GAS
ELECTRIC
WATER
PUBLIC ❑
MAI ING ADDR S
Ownership
ZIP
Actual Set Backs in Feet to:
1-`+ 7 /,ti
UTILITIES
North South East West
PRIVATE ❑
SEWER El
public ❑Private ❑
O TFtA TOR
reverse side, and know the same to be true and correct. All provisions of laws and ordinances governing this type of
LICENSE EXPIRES
PHONE
Size of Parcel
Zone Classification
Residential ❑
4.
of construction. SEE ERSE SID REQUIRED INSPECTIONS
/`i Plumbing=
Commercial ❑
ADDRE S
ZIP
Type Const. Occupancy Sprinklered
Mech.
h.
/ (<
SPECIAL
APPROVALS
SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
❑Yes ONO ❑Req'd.
PRELIM.
DESIGNER
-
7: de- TS
PHONE
New Const. Valuation
Remodeled Valuation
Total Bldg. Floor Area
5.
Env. Health
ADDRESS
ZIP
Main Floor
Upper Floors
Garage/Storage
Greenhouse
Planning
CHANGE OF USE FROM
TO
Cover Deck
Uncv. Deck
Fin. Basement
Unfin. Basement
6.
Other (Specify) �=
Engineer
Tech mg Y IN 180 DAYS DATE FS %- 2 5 — 8 PERMIT �' z * 61. 0 11011 -AL
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No. Baths
No. Floors
No. Fin. Rooms
No. Dwellings
TYPE XNEW El ALT. El AD'N. 11 RPL. El MVE.
7. OF ❑ OTHER
❑ BLD. *-PLMB. ❑ MECH. ❑ M.H. ❑ POOL
Certifi. of Exempt.
Required Yes El No❑
Number
WORK
or Variance
Received Yes ❑ No ❑
DESCRIBE WORK
Shorelines/ Flood Hazard
Plans Required ❑
8•
Yes Not Applic. ❑
Received ❑
VALUATION
I SOURCE
OF
GAS
ELECTRIC
WATER
PUBLIC ❑
I SEWAGE
SEPTIC ❑
Ownership
FEES COLLECTED
9
UTILITIES
PRIVATE ❑
SEWER El
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
work will be complied 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 ERSE SID REQUIRED INSPECTIONS
/`i Plumbing=
SIGNATURE OF APPLICATION �y
OWNER OR AGENDATE 7 33
Mech.
h.
SPECIAL
APPROVALS
SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PRELIM.
FINAL DATE
-
7: de- TS
Plan Check
Env. Health
5
SEPA
Modular/
Planning
5
MFG.Home
Fire
Prevent.
Other (Specify) �=
Engineer
Utilities
5
TOTAL $
SEPAv
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
l "�
PERMIT IS NONTRANSFERABLE
Plans
Exam.
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
Tech mg Y IN 180 DAYS DATE FS %- 2 5 — 8 PERMIT �' z * 61. 0 11011 -AL
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