1983, 04-05 Permit: 83A-2593 Plumbing FixturesPLAN NUMBER
APPLICATION/PERMIT
SPOKANE COUNTY - DEPARTMENT OF BUILDING & SAFETY
• NORPH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
STREET ADDRESS PARCEL NO.
2. LOT I BLOCK SUBDIVISION LEGAL DESCRIPTION:
OWNER
3.
MAILING ADDRESS
C TRACTOR _
4. oc.0 Stcc, �f-cr�ilaJr� 9 ; -f4+,
ADB aas 7 _
PHONE
PHONE
New Const. Valuation
Remodeled Valuation
Total Bldg. Floor Area
ZIP
LICENSE EXPIRES
PHONE
ADDRESS
ZIP
ZIP��/ /
North South East West
Size of Parcel Zone Classification Residential ❑
Commercial ❑
Type Const. Occupancy Sprinklered
❑Yes ❑No ❑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
Deck
Fin, Basement
Unfin. Basem(
6.
Tncv.
No. Baths No.
Floors
No. Fin. Rooms
No. Dwellings
TYPE t�NEW El ALT. El AD'N. 1:1 RPL. El MVE.
% OF ❑OTHER
WORK El BLD. WLPLMB. ElMECH. ElM.H. E) POOL
Certifi. of Exempt.
Required
Yes[--] No❑
Number
orVariance
Received
Yes❑ No r-1
DESCRIBE WORT(
Shorelines/ Flood Hazard
Plans Required
❑
8 • 6 lc ruo £ 5
Yes❑ Not Applic. ❑
Received ❑
VALUATION
SOURCE
OF
AS
ELECTRIC
WATER
PUBLIC 11
I SEWAGE
SEPTIC 11
Ownership
FEES
FEES COLLECTED
9
I
PRIVATE ❑
SEWER 1:1
El Private C]UTILITIES
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 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 proyleiaas of any other state or local law regulating construction or the performance
of construction. SEE REVERS DE FOR REQUIRED INSPECTIONS
Plumbing
SIGNATURE OF APPLICATION i��3
OWNER OR AGENT DATE -
Mech.
SPECIAL APPRO LS SPECIAL C NDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PRELIM. FINAL DATE ^
�
Env. Health (7� 4uC
Planning .�I ��,►�G
Fire
Prevent.
Engineer Lfi 44
Utilities
SEPA
Plans PERMIT IS NONTRANSFERABLE
Exam. PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
Bech'ng 5•� IN 180 DAYS
Plan Check
SEPA
Modular/
MFG.Home
Other (Specify)
PERMIT NUMBER
0-a A — :2
,TOTAL $
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATE PERMIT NO. 9. 3 z
o 5 r 8
*45,OOd0-
TOTAL
CL
Q
C.3
W
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