1983, 11-16 Permit: 83B-1749 Mechanical FixturesPLAN NUMBER APPLICATION/PERMIT
SPOKANE COUNTY — DEPARTME14T OF BUILDING & SAFETY
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
STREETd
1.
LOT
2.
OWNER
3.
MAILING
4
5.
ADDRESS
APPLICANT: COMPLETE NUMBERED SPACES —PRESS HARD TO MAKE 3 COPIES
PARCEL NO.
n 1-� r-,<1�1
DRESS
s _5v e LALE-
JLICENSEE)
lAli;' U-
ZIP Actual Set BacKsin Feet to:
+ North South East West
PHO _E =� Size of Parcel Zone Classification Residential ❑
Commercial ❑
ZIP L Type Const. Occupancy Dyes Spr❑Norte ❑ Req 'd.
PHONE New Const. Valuation Remodeled Valuation Total Bldg. Floor Area
ZIP Main Floor I Upper Floors I Garage/ Storage I Greenhouse
CHANGE OF USE FROM
TO
Cover Deck
Uncv. Deck
Fin. Basement
Unfin. Basement
s.
I
No. Baths No.
Floors
No. Fin. Rooms
No. Dwellings
TYPE NEW 11 ALT. ❑ AD'N. El RPL. ❑ MVE.
7 OF ❑OTHER
WORK 1:1 BLD. ElPLMB. 1:1MECH. ElM.H. ❑ POOL
Certifi.ofExempt.
Required
Yes❑ No El
Number
or Variance
Received
Yes ❑ No ❑
DESCRIBEWORK// 1 �/j�;
8. "7 wee, �4f/%�
Shorelines/Flood Hazard
Plans Required ❑
1 / / �'/L'i - KC�,�
��t 'i �� �l
Yes El Not Applfc. ❑
Received ❑
VALUATION
SOURCE
OF
GAS
ELECTRIC
WATER
PUBLIC ❑
SEWAGE
SEPTIC F-1
Ownership
FEES COLLECTED
9
PRIVATE ❑
SEWER ❑
Public 1:1 Private ElUTILITIES
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
SIGNATURE OF APPLICATION
OWNER OR AGENT DATE
Mech.
SPECIAL APPROVALS
SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
Plan Check
PRELIM. FINAL DATE
Env. Health
SEPA
Planning
Modular/
MFG. Home
Fire
Prevent.
Engineer
Other (Specify)
Utilities
�j
TOTAL $
SEPA
WHEN MACHINE VALIDATED IN
Plans
T IS NONTRANSFERABLE
PERMIT
THIS BECOMES A PERMIT.
Exam.
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
PERMIT NUMBER
63,e IY
Building IN 180 DAYS
Tech. z DATEISr18 1 U —4 3PERMITL . *1 9Ou
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