1983, 10-12 Permit App 83B-335 Gas PipingPLAN NUMBER
APPLICATION/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 /�
1. 2% 9 G, C: O
LOT
2.
3.
DER ?La 0
MAI C-}9°Rm. &/eig2/9/1.
BLOCK
SUBDIVISION
CONTfj1ATite 0�
4.
�/(ADDC//ESf��j'' �CS6467T
DESIGNER
5.
ADDRESS
P...N
LICEt`j$6 r;5e
CHANGE OF USE FROM
PHONE
990 6
4E 5W975-
PHONE
ZIP
TO
TYPE 0 NEW 0 ALT. [ - b'N. 0 RPL. 0 MVE.7. OF ❑OTHER
WORK 0 BLD. 0 PLMB. AECH. 0 M.H. 0 POOL
D SCRIBE WORK
GAS
ELECTRIC
PARCEL NO.
LEGAL DESCRIPTION:
Actual Set Backs in Feet to:
North (South (East ( West
Size of Parcel l Zone Classification
Type Const.
Occupancy
New Const. Valuation
Residential 0
Commercial ■
Spr'nklered
Yes ❑No ❑Req'd.
Remode ed Valuation
Total Bldg. Floor Area
Upper Floors
Cover Deck
No. Baths
Garage/Storage
Uncv. Deck
No. Floors
Certifi. of Exempt.
or Variance
Fin. Basement
Greenhouse
No. Fin. Rooms
Required Yes❑ No❑
Received Yes No❑
Unfin. Basement
No. Dwellings
Number
Shorelines/Flood Hazard
Yes❑ Not Applic. ❑
Ownership
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 REVERSE SIDE FOR REQUIRED INSPECTIONS
SIGNATURE OF
OWNER OR AGENT
SPECIAL APPROVALS
PRELIM. FINAL DATE
Env. Health
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
APPLICATION
DATE ��'
SP CIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
moo'
PERMIT IS NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
Plans Required ❑
Received 0
FEES COLLECTED
Building
Plumbing
Mech.
Plan Check
SEPA
Modular/
MFG. Home
Other (Specify)
Oov
TOTAL $
PERMIT NUMBER
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATISSUEJ 2 — 8 3
PERMIT N.3.5 z.
*18.00iQAL