1983, 10-21 Permit 83B-236 Plumbing FixturesSTREET ADDRESS
1.
LOT
2.
BLOCK
MrrL It/A4 It)N /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
SUBDIVISION
3.
MAILING ADDRESS
OWNER/00c 5
Orev.5-74
PHONE
PHONE
PARCEL NO.
LEGAL DESCRIPTION:
CONTRACTOR ff a ILICENSEEXPIRES
4.
ADDRESS/� t/ : 4N //
DESIGNER
5.
ZIP
PHQNE
Wc397/
ZIP Sxa
PHONE
Actual Set Backs in Feet to:
North 'South
Size of Parcel
East West
Zone Classification
ADDRESS
6.
CHANGE OF USE FROM
ZIP
TO
TYPE NEW ❑ ALT. ❑ AD'N. ❑ RPL.
7. OF BLD. XPLMB. ❑ MECH. ❑ M.H.
WORK
9.
DESCRIBE WORK �ro /z-,
VALUATION
❑ MVE.
❑ POOL
❑ OTHER
Type Const. I Occupancy
Residential ❑
Commercial ❑
Sprinklered
❑Yes ❑No ❑Req'd.
New Const. Valuation I Remodeled Valuation
Cover Deck
Total Bldg. Floor Area
Main Floor (Upper Floors IGaragelStorage 1
Greenhouse
IUncv. Deck
No. Baths I No. Floors
Fin. Basement
No. Fin. Rooms
Certifi. of Exempt.
or Variance
(r/141�
SOURCE GAS ELECTRIC
F
UTILITIES
WATER
PUBLIC Cl
PRIVATE ❑
SEWAGE
SEPTIC ❑
SEWER ❑
Required Yes❑ No❑
Received Yes CI No El
Unfln. Basement
No. Dwellings
Number
Shorelines/Flood Hazard Plans Required 0
Yes❑ Not Applic. 0 Received 0
Ownership
Public 0 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-
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 INS CTIONS
SIGNATURE OF
OWNER OR AGENT c��'��
SPECIAL APPROVALS
PRELIM. FINAL DATE
Env. Health
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
APPLICATION
/�3
DATE %L'�
SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
/9 /'—;)kli,ts
PERMIT IS NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
FEES COLLECTED
Building
Plumbing
Mech.
Plan Check
SEPA
Modular/
MFG. Home
Other (Specify)
TOTAL $
8I
PERMIT NUMBER
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
10-1V-83 236S5
*81.00ae
DATE ISSUED
PERMIT NO. TOTAL