1983, 05-02 Permit 83A-3517 Plumbing FixturesPLAN 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. • I Ltd'
LOT BLOCK SUBDIVISION
2.
3.
OW ER j
MAILING ADDRESS , r
i`3c� h Gov
tom(
COST C
4. ADDRESS
PHONE
LICENSE EXPIRES
PHONE
ZIP
L
C?
PARCEL NO.
LEGAL DESCRIPTION:
Actual Set Backs in Feet to:
North South East West
DESIGNER
5.
ADDRESS
CHANGE OF USE FROM
PHONE
ZIP
PHONE
ZIP
TO
TYPE eNEW ❑ ALT. ❑ AD'N. ❑ RPL. ❑ MVE.
7. WORK ❑ BLD. �LMB. ❑ MECH. ❑ M.H. ❑ POOL ❑OTHER
8. DESCRIBE WORK I
VALUATION
9.
SOURCE
OF
UTILITIES
GAS
ELECTRIC
WATER
PUBLIC 0
PRIVATE ❑
SEWAGE
SEPTIC 0
SEWER ❑
Size of Parcel
Zone Classification
Residential ❑
Commercial ❑
Type Const. l Occupancy Spr nklered
❑Yes ❑No ❑Req'd.
New Const. Valuation Remodeled Valuation Total Bldg. Floor Area
Main Floor
Upper Floors Garage/Storage
Cover Deck
No. Baths
Uncv. Deck
No. Floors
Certif I. of Exempt.
or Variance
Fin. Basement
Greenhouse
No. Fin. Rooms
Required Yes CI
No ❑
Received Yes Noll
Shorelines/Flood Hazard
Yes❑ NotApplic. ❑
Ownership
Public 0 Private 0
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 constructi'ih. SEE REVERSE SIDE FOR REQUIRED INSPECTIONS
SIGNATURE OF APPLICATION
OWNER OR AGENT �G'l'�- DATE ` 0
SPECIAL APPROVALS
PRELIM. FINAL DATE
Env. Health
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
SPECJA'L CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
1 1/0\ +ram
PERMIT IS NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
Unfin. Basement
No. Dwellings
Number
Plans Requ red ❑
Received 0
FEES COLLECTED
Building
Plumbing
Mech.
Plan Check
SEPA
Modular/
MFG. Home
Other (Specify)
TOTAL $ I��
PERMIT NIJMBER
03* * 1 3.00
* 1 3.008
A *0.00 8
351.6z
05-02-83
z 6479,
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
05'-02-8.3 35L7Z
DATE ISSUED
PERMIT NO.
*13' aAL