1983, 04-12 Permit: 83A-2874 Plumbing FixturesPLAN NUMBER
APPL ICAT ION /PERMIT
FRERMIT NUMBER
SPOKANE COUNTY — DEPARTMENT OF BUILDING & SAFETYA
- 28.E
TYPE NEW ❑ LT. ❑ AD' N. ❑ RPL. ❑ MVE.
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
No. Floors
APPLICANT: COMPLETE NUMBERED SPACES -PRESS HARD TO MAKE 3 COPIES
No. Dwellings
STREET ADDRESS
PARCEL NO.
t Z C v t t•7 "� Bp
WORK ❑ BLD. 1 PLMB. ❑ MECH. ❑ M.H. ❑ POOL
2. LOT
I BLOCK
I SUBDIVISION
Number
LEGAL DESCRIPTION:
or Variance
OWNER
PHONE
PHONE
3. s ,.> > : �v�ES
Shorelines/ Flood Hazard
Gt':.4-Ct-74t
1 ( -T k� E`>
Yes Not Applic. ❑
MAILING ADDRESS
VALUATION
ZIP
Actual Set Backs in Feet to:
ELECTRIC
R—C _E5- K l
O
ally D�_p
North South East West
CONTRACTOR
LICENSE EXPIRES
PHONE
Size of Parcel
zone Classif ication
SEPTIC
"
4. 11i`�.`S ����.
FEES COLLECTED
per} -5 7
UTILITIES
Commerciial0
-
ADDRESS
(= 1 (5 t PFv_ejJEr�t�
/ZII P
�a7.C�<v
Type Const.
Occupancy
Sprinklered
Dyes ❑No ❑Req'd.
DESIGNER
PHONE
New Const. Valuation
Remodeled Valuation
Total Bldg. Floor Area
5.
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 R IONSPlumbing
l •��'
SIGNATURE OF APPLIDATE CATION
ADDRESS
Mech.
ZIP
Main Floor
Upper Floors
Garage/Storage
Greenhouse
CHANGE OF USE FROM
s.
TO
Cover Deck Uncv. Deck
Fin. Basement
Unfin. Basement
TYPE NEW ❑ LT. ❑ AD' N. ❑ RPL. ❑ MVE.
No. Baths
No. Floors
No. Fin. Rooms
No. Dwellings
% OF ❑OTHER
WORK ❑ BLD. 1 PLMB. ❑ MECH. ❑ M.H. ❑ POOL
Cartifi.ofExempt.
Required
Yes❑ No❑
Number
or Variance
Received
Yes❑ No❑
DESCRIBE WORK
8'
Shorelines/ Flood Hazard
Plans Required ❑
1 ( -T k� E`>
Yes Not Applic. ❑
Received ❑
VALUATION
SOOURCE
GAS
ELECTRIC
O
Ownership
9
PUBLICO
SEPTIC
FEES COLLECTED
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 R IONSPlumbing
l •��'
SIGNATURE OF APPLIDATE CATION
OWNER OR AGENT Z
Mech.
PRELIM. FINAL DATE
Env. Health
Planning
Utilities
Plans
Exam
AL CQNDITIOSEE RE
'S 4�ti
� Lu �i `3t-lEri
� Ft,tL 172W � /V
ERSE SIDE FOR N
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 $ 4k. 00 I
WHEN MACHINE VALIDATED IN THIS S
THIS BECOMES A PERMIT.
DATE 1117ED 1 2—" 5 PERMIT �J 7. 4 z 0, 4 10 OTOTAL
112 -
CD O
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W
J
FL