1983, 12-05 Permit 83B-2250 Plumbing FixturesAPPLICATION/PERMIT
SPOKANE COUNTY - BUILDING CODES DEPARTMENT
PERMIT NUMBER
J 2 l 'o
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
JOB ADDRESS
1. t-L
LOT BLOCK SUBDIVIS N
OWNER
LEGAL DESCRIPTION — SEE ATTACHED
ADDRES
4- C/..
ADDRE S
DESIGNER
5 ADDRESS
CHANGE OF USE FROM
6.
TO
PHONE
ZI P
PHONE
PARCEL NUMBER/S
ZIP
ic'.3,7
PHONE
ZIP
Actual Set Backs in Feet
North
Size of Parcel
Type Const.
South
East West
Zone Classification
Building Area in Sq.
_i Garage Area
Sprinklered
Occupancy
❑Yes ❑No ❑ Req'd.
Valuation Ft.
Main Floor I Upper Floors
Area of Decks
Finished Basement
Storage
Unfin. Basement
TYPE
7. OF
WORK
8.
9.
1 EW❑, //ALT. El AD N. ❑ RPL. ❑ MVE_
❑ BLD, E 4LMB. ❑ MECH. ❑ M.H. ❑ POOL
DESCRIBE WORK
VALUATION
❑ OTHER
No. Baths
No. Stories
No. Rooms
No. of Dwellings
CERTIFICATE
of EXEMPTION
Req'd.
Rec'd.
Not Req'd.
SOURCE GAS
OF
UTILITIES
yv1/4:1.
ELECTRIC WATER
SEWER
Enum. Dist. I Location (Area)
Ownership
Public O Private ❑
USE CODE
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 authority 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
DATE OF APPLICATION / V -- SIGNATURE OF APPLICANTltL`"'�
SPECIAL APPROVALS
NAME DATE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examine
SEPA Checklist
SPECIAL CONDITIONS:
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
FEES COLLECTED
Single $
Building
,;•
Plumbing
l2
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL $ `%
03* x 1 7,00
*17.006
*0,00 8
224.9
12-05-83
2 6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
Yr
12_0 -83,
DATE ISSUED
22.'5.0z
PERMIT NO.
*1700
TOTAL
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2,
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1
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x
31
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