1984, 03-30 Permit: 84A-2755 Plumbing FixturesPLAN NUMBER
APPL ICAT ION /PERMIT
PERMIT NUMBER
PRELIM. FINAL
DATE
SPOKANE COUNTY - DEPARTMENT OF BUILDING & SAFETY
_
ADDRESS
ZIP
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
Floors
Garage/Storage
Greenhouse
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
STREET ADDRESS
PARCEL NO.
i S Z�rrU �I ►�E
) F-ii.0 k-tiT2
_ _
TO
Cover Deck
LOT
BLOCK
SUBDIVISION
LEGAt DESCRIPTION:
2.
I
No. Baths No.
1
OWNER
PHONE
PHONE
3.
1�ac.��dL»T� N tib��
�
7. OF��� ❑ OTHER
MAILING ADDRESS
ZIP
Actual Set Backs in Feet to:
WORK El BLD. )LTPLMB. ❑ MECH. ❑ M.H. ❑ POOL
ayaria^ce empt.
Required
North South East West
Number
�,1
CONTACTOR
Received
LICENSE EXPIRES
PHONE
Size of Parcel
ZoneClassification
Residential
8•
4.
Received ❑
VALUATION
SOURCE
OF
GAS
ELECTRIC
I WATER
PUBLIC El
Commercial ❑
I Ownership
ADDRESS
ZIP
Type Const.
Occupancy
Sprinklered
PRIVATE 11
SEWER ❑
public ❑Private ❑
❑Yes ❑No ❑Req'd.
—
DESIGNER
PHONE
New Const. Valuation
Remodeled Valuation
Total Bldg. Floor ,area
of construction. SEE REVERS DE FOR Re6UIRED INSPECTIONS
Plumbing
SIGNATURE OF APPLICATION :f �j ),._ ��
Jt "
OWNER OR AGENT DATE >> /
Mecn.
_ t
5.
SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PRELIM. FINAL
DATE
TOIL E"T`S
L a�av S
Env. Health
ADDRESS
ZIP
Main Floor Upper
Floors
Garage/Storage
Greenhouse
Planning
i S Z�rrU �I ►�E
) F-ii.0 k-tiT2
CHANGE OF USE FROM
TO
Cover Deck
Uncv. Deck
Fin. Basement
I Unfin. Basement
6.
Utilities
No. Baths No.
1
Floors
No. Fin. Rooms
No. Dwellings
TYPE I/NEW ❑ ALT. ❑ AD' N. ❑ RPL. ❑ MVE.
7. OF��� ❑ OTHER
PERMIT IS NONTRANSFERABLE
Plans
WORK El BLD. )LTPLMB. ❑ MECH. ❑ M.H. ❑ POOL
ayaria^ce empt.
Required
Yes❑ No❑
Number
�,1
Received
Yes❑ No❑
DESCRIBE WORK
Shorelines/ Flood Hazard
Plans Required ❑
8•
Yes❑ Not Applic. ❑
Received ❑
VALUATION
SOURCE
OF
GAS
ELECTRIC
I WATER
PUBLIC El
SEWAGE
SEPTIC ❑
I Ownership
FEES COLLECTED
g
I UTILITIES
PRIVATE 11
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 REVERS DE FOR Re6UIRED INSPECTIONS
Plumbing
SIGNATURE OF APPLICATION :f �j ),._ ��
Jt "
OWNER OR AGENT DATE >> /
Mecn.
SPECIAL APPROVALS
SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PRELIM. FINAL
DATE
TOIL E"T`S
L a�av S
Env. Health
I Y_ -r '�;X' NSC
Planning
i S Z�rrU �I ►�E
) F-ii.0 k-tiT2
Fire
Prevent.
Engineer
Utilities
SEPA
PERMIT IS NONTRANSFERABLE
Plans
Exam.
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
Building
�,1
Plan Check
SEPA
Modular/
MFG. Home
Other (Specify)
TOTAL $ 6 � V O':'
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATE ISSi II 0 — 8 4 PERMIT 20 5. 5 z
*62.00100tAL