1983, 05-09 Permit: 83A-3809 Plumbing FixturesPLAN NUMBER APPLICATION/PERMIT
SPOKANE COUNTY — DEPARTMENT OF BUILDING & SAFETY
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
1.
STREET ADDRESS
Required Yes❑ No❑
LOT
BLOCK
2.
Received Yes ❑ No ❑
DESCRIBE WORK
8'
OWNER
(r•
3.
yes Not Applic. ❑
MAILING ADDRESS
VALUATION
9
4
APPLICANT: COMPLETE NUMBERED SPACES —PRESS HARD TO MAKE 3 COPIES
PARCEL NO.
SUBDIVISION LEGAL DESCRIPTION:
PHONE IPHONE
ZIP
CONTRAQTOR r LICEN XP S PHONE
4. o'e
ADDRESS ZIP
DESIGNER PHONE
5.
ADDRESS ZIP
CHANGE OF USE FROM TO
6.
PERMIT NUMBER
qNewConst.
tual Set Backs In Feet to: 7, * x ci
rth South East West
e of Parcel Zone Classification J -
Residential ❑
Commercial ❑
C!,
; b ! 3
pe Const. Occupancy Dyes Spr❑Norte ❑Req'd.
!� 9
Valuation Remodeled Valuation Total Bldg. Floor Area
Main Floor UpperFloors(Garage/Storage
Cover Deck I Uncv. Deck I Fin. Basement
No. Baths No. Floors No. Fin. Rooms
7• OFPE 'NEW ❑ALT. ❑ AD'N. ❑RPL. ❑ MVE. El OTHER
Greenhouse
Unfln. Basement
No. Dwellings
WORK ❑ BLD. DrLMB. ❑ MECH. ❑ M.H. ❑ POOL
Certif1.ofExempt.
Required Yes❑ No❑
Number
or Variance
Received Yes ❑ No ❑
DESCRIBE WORK
8'
Shorelines/ Flood Hazard
Plans Required ❑
yes Not Applic. ❑
Received ❑
VALUATION
9
SOURCE
OF
GAS
ELECTRIC
PUBLWATER
SEPTISEWAGE
Ownership
FEES COLLECTED
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 resume to
P P 9 9 P p 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 REVERSE SIDE FOR REQUIRED INSPECTIONS
Plumbing R 6
APPLICATION
SIGNATURE OF�f 4�."_�"-
OWNER OR AGENT �C ?7
DATE ee�_•
Mach.
SPECIAL APPROVALS
SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PRELIM. FINAL DATE
G
Plan Check
Env. Health
/
p,
SEPA
Planning
d
/ �(
MFG. Home
Fire
Prevent.
Engineer/ %�'� Other(Specify)
Utilities /� �' • /r s
/�/ TOTAL $
SEPA /c�
WHEN MACHINE VALIDATED IN THIS SPACE,
Plans PERMIT IS NONTRANSFERABLE THIS BECOMES A PERMIT.
Exam. PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
Building IN 180 DAYS 55 _ (()� 9 _ j R n (�
Tech. DATEgSSUED�' PERMiTj 9. O' 9 c5 * �' O O #&AL
CL
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