1983, 06-15 Permit: 83A-5301 Plumbing FixturesPLAN NUMBER APPLICATION/PERMIT PERMIT NUMBER
SP6KANE COUNTY - DEPARTMENT OF BUILDING & SAFETY
NORTH 811 JEFFERSON / SPOKANE, WASfJINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
STREET ADDRESS
PARCEL NO.
�. 1
LOT
BLOCK
SUBDIVISION
LEGAL DESCRIPTION:
2.
!moi
O NES
PHONE
PHONE
3.
Prevent.
AILING ADDRESS
ZIP
ua Set Backs in Feet to:
Other (Specify)
S 00
TOTAL $
North South East West
C ACTOR
LIgE EXP RES
PH, _E
Size of Parcel
Zone Classification
Residential ❑
SEPA
4.
S
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
Plans
Commercial ❑
DDRES
ZIP
Type Const.
Occupancy
Sprinklered
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
0 '6 -15 -8 35 j 01 z
.
Tech mg
❑Yes ❑No ❑Req'd.
J""
DESIGNER
ONE
New Const. Valuation
Remodeled Valuation
Total Bldg. Floor Area
v
ADDRESS
ZIP
Main Floor Upper
Floors
Garage/Storage
Greenhouse
CHANGE OF USE FROM
6.
TO
Cover Deck
Uncv. Deck
Fin. Basement
Unf in. Basement
�, T ,
",.�;-
TYPE ,NEW ❑ALT. El AD' N. ❑RPL. F-1 MVE.
No. Baths No.
Floors
No. Fin. Rooms
No. Dwellings
-
7• OF ❑ OTHER
WORK ❑ BLD. )d PLMB. ❑ MECH. ❑ M.H. ❑ POOL
j
Certifi. of Exempt.
Required Yes❑ No❑
Number
or Variance
Received Yes❑ No❑
DESCRIBE WORK
8' ��
Shorelines/ Flood Hazard
Plans Required ❑
Yes Not Applic.❑
Received ❑
VALUATION
9•
I SOOUFCE
GAS
ELECTRIC
PUBLICO
SEPTIC O
Ownership
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 p visions of any other state or local law regulating construction or the performance
d v
of construction. SEE REVERWS-JEWFOR RQ0lJIR§P INSPECTIONS
Plumbing
SIGNATURE OF APPLICATION /
/�_
OWNER OR AGENT DATE G <,'�
Mach.
SPECIAL APPROV L
SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PRELIM. FINAL DATE
Env. Health
% v(r,/
Plan Check
*65,000CNAL
a.
O
C)
W
J
LL
��ULOt'a
,.
SEPA
Planning
!moi
Modular/
MFG.H Home
Fire
Prevent.
�_ i`
� r�
�'�C✓l% r ���/'�
PERMIT IS NONTRANSFERABLE
Other (Specify)
S 00
TOTAL $
Engineer
Utilities
SEPA
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
Plans
Exam.
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
0 '6 -15 -8 35 j 01 z
.
Tech mg
-
1 7
DATE ISSUED PERMIT ND.
*65,000CNAL
a.
O
C)
W
J
LL