1984, 02-29 Permit App 84A-1684 Water HeaterPLAN NUMBER
APPLICATION/PERMIT
SPOKANE COUNTY — DEPARTMENT OF BUILDING & SAFETY
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
1.
2.
3.
ST ADDRESS
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APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
SUBDIVISION
MAILIfe CDR S 7
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CONTRAM
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LICENSE,.EXPIR€S
PHONE
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ADDRESS:
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DESIGNER
ADDRESS
CHANGE OF USE FROM
TYPE 0 NEW
7. OF WORK 0 BLD.
PHONE
ZIP
TO
❑ ALT. ❑ AD' N. ❑ RPL.
❑ PLMB.' MECH. 0 M.H.
❑ MVE.
❑ POOL ❑ OTHER
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DES IBE WORK ,�
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SIGNATURE OF
OWNER OR AGENT
SOOURCE
UTILITIES
GAS
ELECTRIC
WATER
PUBLIC 0
PRIVATE ❑
SEWAGE
SEPTIC 0
SEWER 0
PARCEL NO.
LEGAL DESCRIPTION:
Actual Set Backs in Feet to:
North South East West
Size of Parcel
Type Const.
Occupancy
New Const. Valuation
Main Floor
Zone Classification
Residential ❑
Commercial 0
Spr nklered
❑Yes ❑No ❑Req'd.
Total Bldg. Floor Area
Remodeled Valuation
Upper Floors
Cover Deck
No. Baths
Garage/Storage
Uncv. Deck
No. Floors
Certlfi. of Exempt.
or Variance
Greenhouse
Fin. Basement
No. Fin. Rooms
Required Yes ❑ Non
Received Yes Non
Shorelines/Flood Hazard
Yee ❑ NotApplic. 0
Ownership
Public ❑ Private 0
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 REV E SIDE FOR 7QUIRED INSPECTIONS
axe
DPLICATION _L /) /�4/
DATE
SPECIAL APPROVALS
PRELIM. FINAL DATE
Env. Health
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
CIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
39 j e7r7> 1570 — 6 t's1 14z-a)
of it p,Ayng O/
P(P/A)C
PERMIT IS NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
Unfin. Basement
No. Dwellings
Plans Required 0
Received 0
FEES COLLECTED
Building
Plumbing
Mech.
Plan Check
SEPA
Modular/
MFG. Home
Other (Specify)
TOTAL $
'}r
00
Pti4r U/ 7 €�
e
04* -*21,00
*21,006
A *0.00
16a3-
02-29-84
6.479,
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATE1S UED?` 9 - 8 4'
1.
PERMIIlN6.8, 4 2
*' 21, 0 0 at AL