1984, 02-21 Permit: 84A-1437 Plumbing FixturesPLAN NUMBER APPLICATION/ PERMIT
SPOKANE COUNTY — DEPARTMENT OF BUILDING & SAFETY
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
or Variance Received Yes❑ No❑
DESCRIBE WORK Shorelines/ Flood Hazard Plans Required ❑
8. i2� Yes Not Applic. ❑ Received ❑
VALUATION SOURCE GAS ELECTRIC I WATER I SEWAGE Ownership
9 OF PUBLIC 1:1 SEPTIC ❑ FEES COLLECTED
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
Y
l:
1.
STREET ADDRESS
SEWER ❑
PARCEL NO.
-i 1-71
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-
Lor
BLOCK
SUBDIVISION
of construction. SEE REV SE SIDE FOR REQUIRED INSPECTIONS
LEGAL DESCRIPTION:
SIGNATURE OF ZAPPLICATION Z; f
2.
OWNER OR AGENT — DATE Z�
Mach.
SPECIAL APPROVALS
SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PRELIM. FINAL DATE
Plan Check
OWNER
PHONE
u
PHONE
3
f4 �aJS'f
2
SEPA
Modular/
Planning
MAILINGADDRESS
ZIP
Actual SetBacks nFeet to:
MFG. Home
V7i - �• `� v
t_ ;"�•�
North South East West
C NTRACT R f
(�
LICENSE EXPIRES
P NE
Size of Parcel
Zone Classification
Residential❑
4
t'j6
_
Commercial ❑
ADDRESS
22,E
ZIP
Type Const.
Occupancy
Sprinklered
v, (,
❑Yes ❑No
❑Req'd.
DESIGNER
PHORE
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.
TYPE _NEW
No. Baths
No. Floors
No. Fin. Rooms
No. Dwellings
7•
, •CI ❑ALT. ❑ AWN. ❑RPL.
OF
WORK ❑ BLD. 2 PLMB. ❑ MECH. ❑ M.H.
El MVE.
❑ OTHER
❑ POOL
Certifi.ofExempt.
Required Yes❑ No❑
Number
or Variance Received Yes❑ No❑
DESCRIBE WORK Shorelines/ Flood Hazard Plans Required ❑
8. i2� Yes Not Applic. ❑ Received ❑
VALUATION SOURCE GAS ELECTRIC I WATER I SEWAGE Ownership
9 OF PUBLIC 1:1 SEPTIC ❑ FEES COLLECTED
- 51 K_
Utilities
SEPA
plansPERMIT IS NONTRANSFERABLE
Exam. PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
Building IN 180 DAYS
PERMIT NUMBER
UTILITIES
Y
l:
PRIVATE ❑
SEWER ❑
Public ❑ Private ❑
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 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 REV SE SIDE FOR REQUIRED INSPECTIONS
Plumbing
SIGNATURE OF ZAPPLICATION Z; f
OWNER OR AGENT — DATE Z�
Mach.
SPECIAL APPROVALS
SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PRELIM. FINAL DATE
Plan Check
Env. Health
2
SEPA
Modular/
Planning
MFG. Home
Are
Prevent.
Other (Specify)
Enaineer
I
I I
- 51 K_
Utilities
SEPA
plansPERMIT IS NONTRANSFERABLE
Exam. PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
Building IN 180 DAYS
PERMIT NUMBER
TOTAL $ –a—
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT. 3x
DATE'�t1ED� 8 4 PERMITLO4 . / 7
z * 5 8. 0 0 �b'
tL
O
C.3
W
J_
ILL.
(;
Y
l:
TOTAL $ –a—
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT. 3x
DATE'�t1ED� 8 4 PERMITLO4 . / 7
z * 5 8. 0 0 �b'
tL
O
C.3
W
J_
ILL.