1983, 04-19 Permit: 83A-3079 Plumbing FixturesPLAN NUMBER APPL ICAT ION /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
STREETADDRESS PARCEL NO.
LOT BLOCK SUBDIVISION LEGAL DESCRIPTION:
2.
OWNERPHONE
PHONE
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3. a
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MAILING ADDRESS
ZIP
Actual Set Backs In Feet to:
//,/
North South East
West
CONTRACTOR
LICENS XPIRES
PHO /
Size of Parcel
Zone Classification
Residential
4.
Commercial ❑
ADDRESS
ZIP
Type Const.
Occupancy
Sprinkiered
Dyes ONO ❑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
Uncv. Deck
Fin. Basement
Unfin. Basement
s.
No. No.
Floors
No. Fin. Rooms
No. Dwellings
TYPEDAWN.
TY &VEW ❑ ALT. ❑ AWN. ❑ RPL. ❑ MVE.
�tlls
7 ❑ OTHER
WORK ❑ BLD. 1arPLMB. ❑ MECH. ❑ M.H. ❑ POOL
Certifi.ofExempt.
Required
Yes❑ NOD
Number
or Variance
Received
Yes❑ No❑
DESCRIBE W9
Shorelines/ Flood Hazard
Plans Required El8.
[
_F
Yes❑ Not Applic. ❑
Received ❑
VALUATION
I SOOURCE
GAS
ELECTRIC
PUBLIWATER
G❑E
SEPT C
Ownership
FEES COLLECTED
9.
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
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 REVERSE SIDE FOR REQUIRED INSPECTIONS
Plumbing
SIGNATURE OF �7�s G� APPLICATION
/f �
OWNER OR AGENT / DATE
-�
Mach.
SPECIAL APPROVALS
PRELIM. FINAL D
Env. Health
Planning
Utilities
SEPA
Plans
Exam.
Building
Tech.
SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
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PERMIT IS NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
Plan Check
SEPA
Modular/
MFG. Home
Other (Specify)
TOTAL $ S �_r_l
PERMIT NUMBER
3 — U
WHEN MACHINE VALIDATED IN THIS
THIS BECOMES A PERMIT.
DATEO4— o
ISSUED 9_ PERMITJ.7' 9 z h O %YAL
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