1983, 04-12 Permit: 83A-2879 Plumbing FixturesPLAN NUMBER APPL ICAT ION /PERMIT PERMIT NUMBER
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 I PARCEL NO.
LOT BLOCK I SUBDIVIS11
2.
OWNER
3. LC RV_ fin,s�
MAILING ADDRESS
CONTRACTOR
4. 5 . �? L .y� t..�� r ✓�
ADDRESS
DESIGNER
5.
ADDRESS
South I East I West
cone Uassmcauon Residential ❑
Commercial ❑
Occupancy Sprinklered
❑Yes ❑No ❑Req'd.
n I Remodeled Valuation I Total Bldg. Floor Area
Upper
CHANGE OF USE FROM TO Cover Deck Uncv. Deck Fin. Basement Unfin. Basement
6.
TYPE NEW ❑ALT. El AD'N. 1:1 RPL. El MVE. No. Baths No. Floors No. Fin. Rooms No. Dwellings
OF I
7. WORK El BLD. 11'PLMB. ❑ MECH. ❑ M.H. ❑ POOL El OTHER Certffi.ofExempt. Required Yes❑ No❑ Number
or Variance Received Yes❑ No❑
DESCRIBE WORK
8•
Shorelines/ Flood Hazard
Plans Required ❑
1-7 r x-rm pf5
ZIP
aa,__XO \
Actual Set
North
LICENSE EXPIRES
PHH+ONE
Size of Pard
ELECTRIC
ZIP
C11,61Z1CF-)
Type Const.
Ownership
PHONE
New Const.
9•
ZIP
Main Floor
South I East I West
cone Uassmcauon Residential ❑
Commercial ❑
Occupancy Sprinklered
❑Yes ❑No ❑Req'd.
n I Remodeled Valuation I Total Bldg. Floor Area
Upper
CHANGE OF USE FROM TO Cover Deck Uncv. Deck Fin. Basement Unfin. Basement
6.
TYPE NEW ❑ALT. El AD'N. 1:1 RPL. El MVE. No. Baths No. Floors No. Fin. Rooms No. Dwellings
OF I
7. WORK El BLD. 11'PLMB. ❑ MECH. ❑ M.H. ❑ POOL El OTHER Certffi.ofExempt. Required Yes❑ No❑ Number
or Variance Received Yes❑ No❑
DESCRIBE WORK
8•
Shorelines/ Flood Hazard
Plans Required ❑
1-7 r x-rm pf5
Yes Not Applic. ❑
Received ❑
VALUATION
SOOFCE
GAS
ELECTRIC
PUBLIC ❑
SEPT CGO
Ownership
FEES COLLECTED
9•
I UTILITIES
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
of construction. SEE REVERSE SIDE FOR REQUIRED INSPECTIONS
Plumbing -75,00
SIGNATURE OF APPLICATIQN 2
OWNER OR AGEN DATE
Mech.
SPECIAL APPROVALS
SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
Plan Check
PRELIM. FINAL DATErl..l2,
� pRW+r3
1 H � O rkT(1.
Env. Health
) S Z AN 0 96
SEPA
Planning
Modular/
l toc t -r S i NSG
MFG. Home
Fire
Prevent.
Engineer tS L �, S Other (Specify)
Utilities j- TKA
( SiLowEtz TOTAL $
SEPA
MACHINE VALIDAT
Plans PERMIT IS NONTRANSFERABLE HEIS BECOMES A PERMIT.
Exam. PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
Building IN 180 DAYS Q A 1 2_ 8 3
Tech. �� DATETSSUED`
.r
b3
PERMITO. 7` 9 6Z 7 3` O O iloii-AL