1983, 05-18 Permit: 83A-4215 Plumbing FixturesPLAN NUMBER
APPLICATION/ PERMIT
SPOKANE COUNTY - BUILDING CODES DEPARTMENT
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
JOB ADDRESS F -0 -LEGAL DESCRIPTION — SEE ATTACHED
�. 1-- 161011 191
LOT I BLOCK SUBDIVISION
2.
OWNE Ilkle
3.
4
ADDR J ZIP
Actual Set Backs in Feet
4ej`
North South East
West
CONT ¢ I HONE
Size of Parcel
Zone Classification
4' ADD RES I
Type Const.
Occupancy
Sprinklered
114
T7(!J
❑Yes ❑No ❑ Req'd.
DESIGNER PHONE
Valuation
Building Area in Sq. Ft.
5.
ADDRESS ZIP
Main Floor Upper
Floors
Garage Area
Storage
CHANGE OF USE FROM
TO
Area of Decks
Finished Basement
Unfin. Basement
s.
Baths
No. Stories
No. Rooms
No. of Dwellings
TYPENo.
Lf'NEW ❑ALT. ❑ AWN.❑ RPL. ❑ MVE.
7, OF'L ❑OTHER
,_„
CERTIFICATE
Req'd.
Recd.
Not Req'd.
WORK LD. PLMB. ❑ MECH. ❑ M.H. El POOL
of EXEMPTION
DESCRIBE K G
Enum. Dist.
Location (Area)
8 115
FEES COLLECTED
VALUATION
SOURCE
GAS
ELECTRIC
WATER
SEWER
Ownership
USE CODE
9.
OF
UTILITIES
I
Public 11 Private ❑
Single $
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
Building
to give authority 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 00,
Plumbing
—
(� G'
DATE OF APPLICATION � SIGNATURE OF APPLICANT
Mech.
SPECIAL APPROVALS
NAME DATE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SPECIAL CONDITIO S:
ng TecWhici n PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
Plan Check
SEPA
Mobile Home
Other (Specify)
PERMIT d�tj NUMBERy �t�
J
A -+
(i v y * 1'7 0
* `700
6479,
�0
TOTAL $
57—
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
0 5�!-18 ' 8, 3° 4 21, 5 z
DATE ISSUED PERMIT NO.
*5Z00a� -
TOTAL
ri
J
J
6: