1984, 02-03 Permit: 84A-977 Plumbing FixturesPLAN NUMBER APPLICA . /PERMIT
SPOKANE COUNTY — DEPARTMENT OF BUILDING & SAFETY
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 3 COPIES
STREET ADDRESS
3,q r
PARCEL NO.
LOT BLOCK
2.
SUBDIVISION
LEGAL ESCRI*TION:
OWNER
3. K. Gc�k�6
PHONE
PHONE
MAILING ADDRESS
ZIP
Actual Set Backs In Feet to:
Engineer%
North South East West
CO TRACTOR � �i R
4. AL W' P N
LICENSE EXPIRES
PHONE
-2��tG"--0)
Size of Parcel
Zone Classification
Residential ❑
Commercial ❑
ADDRESS �� �� ��
f PTJ I
ZIP
Cl61 eag;
Type Const.
Occupancy
Sprinklered
❑Yes ❑No ❑Req'd.
DESIGNER
PHONE
New Const. Valuation
Remodeled Valuation
Total Bldg. Floor Area
�J.
SOURCE
OF
GGAI SS
ELECTRIC
WATER
PUBLIC ❑
ADDRESS
ZIP
Main Floor
Upper Floors
Garage/Storage
Greenhouse
CHANGE OF USE FROM TO Cover Deck Uncv. Deck Fin. Basement Unfin. Basement
s.
No. Baths No. Floors No. Fin. Rooms No. Dwellings
TYPE;!I-NEW ❑ ALT. ❑ AD' N. ❑ RPL.
❑ MVE.
DATE
�k40
nn
D
Env. Health
El BLD. �FPLMB. ElMECH. ElM.H.
1:1 POOL
❑OTHER
Fire
Prevent.
Engineer%
Certif Lof Exempt.
Required
Yes❑ No❑
Number
WORK
or Variance
Received
Yes❑ No❑
8 DESCRIBE WORK FG0 M ( c swot,
t
-
�
Yes❑Shorel'n�Flood
No pplic.❑
Plansrd Received ❑
VALUATION
SOURCE
OF
GGAI SS
ELECTRIC
WATER
PUBLIC ❑
SEWAGE
SEPTIC 11
Ownership
FEES COLLECTED
9• 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-
thority to violate or cancel the provisions of any other state or local law regulating construction or the performance
of construction. SEE REVERSEWQE FOR REQUIRED INSPECTIONS
SIGNATURE OF APPLICATION
OWNER OR AGENT DATE
NS: (SEE REVERSE SIDE FOR NOTICE)
- W R''d11 1- tA
Plans PERMIT IS NONTRANSFERABLE
Exam. PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
Buil ing _ IN 180 DAYS
Building
Plumbing
Mach.
Plan Check
SEPA
Modular/
MFG.Home
Other (Specify)
TOTAL $
WHEN MACHINE VALIDA7
THIS BECOMES A PERMIT.
DATEy59UEDo 3 eL
PERMIT NUMBER
PERMIT NS. 7, 7 z *58,00M00 fjA L
CL
O
V
LU
J_
ILL
PRELIM. FINAL
DATE
�k40
nn
D
Env. Health
Planning
Fire
Prevent.
Engineer%
Utilities
NS: (SEE REVERSE SIDE FOR NOTICE)
- W R''d11 1- tA
Plans PERMIT IS NONTRANSFERABLE
Exam. PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
Buil ing _ IN 180 DAYS
Building
Plumbing
Mach.
Plan Check
SEPA
Modular/
MFG.Home
Other (Specify)
TOTAL $
WHEN MACHINE VALIDA7
THIS BECOMES A PERMIT.
DATEy59UEDo 3 eL
PERMIT NUMBER
PERMIT NS. 7, 7 z *58,00M00 fjA L
CL
O
V
LU
J_
ILL