1983, 10-07 Permit 83B-991 Gas PipingPLAN NUMBER
A!'t'LI(. A I IUIV / rtrinn I I
SPOKANE COUNTY — DEPARTMENT OF BUILDING & SAFETY
NORTH 811 JEFFERSON / SPOKANE, WA3RINGT-ON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
STREET ADDRESS
. ! iquo ► I 7
2. � BLOCK S IRISION
1.
OWN 4J).J G
3. fv�,.11LLrtf
MAILING ADDRESS
I V:12 M^tiy�-1 I -0
coNT_R/ k1R(G> w
4. ���1J11
ADDRESS
PHONE
LIC_NSE EXPIRES
PHONE
ZIP
PHONE
ZIP
PARCEL NO.
LEGAL DESCRIPTION:
Actual Set Backs In Feet to:
North (South [East I West
Size of Parcel 1 Zone Classification
Type Const.
Occupancy
Residential ❑
Commercial 0
Sprinklered
❑Yes ❑No ❑Req'd.
DESIGNER
5. ADDRESS
PHONE
New Const. Valuation
Remodeled Valuation
Total Bldg. Floor Area
ZIP
Main Floor
Upper Floors
Garage/Storage
Greenhouse
CHANGE OF USE FROM
6.
TO
TYPEEW ❑ ALT. 0 AAD'N_ 0 RPL. ❑ MVE.
7.
WORK 0 BLD.0 PLMB.2 ECH. ❑ M.H. ❑ POOL
0 OTHER
Cover Deck
No. Baths
Uncv. Deck
No. Floors
Fin. Basement
No. Fin. Rooms
Unfin. Basement
No. Dwellings
Certifi. of Exempt.
or Variance
Required Yes❑ No❑
Received Yes❑ No❑
Number
8.
9.
DESCRIB�j(VO�K /�NI 61 (V+,t 1
VALUATION_TITISOURCEgLGAS ELEVI(jRIC
OF
UTILITIES
Shorelines/Flood Hazard Plans Required 0
Yes ❑ Not Applic. ❑ Received ❑
WATER
PUBLIC ❑
PRIVATE ❑
SEWAGE
SEPTIC ❑
SEWER 0
Ownership
Public 0 Private 0
I hereby certify that 1 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 R • IRED INSP TIONS
SIGNATURE OF ,_�� � i PTELICATIO
OWNER OR AGENT-�
SPECIAL APPROVALS
PRELIM. FINAL DAT
Env. Health
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
J`%
SPECIAL C• NDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PERMIT IS NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
FEES COLLECTED
Building
Plumbing
Mech. I
Plan Check
SEPA
Modular/
MFG. Home
Other (Specify)
TOTAL $
04* *1200
*12.006
A *000
9,02
10-07-83
g 6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
10 -0 7 - 9.1z
DATE ISSUED
PERMIT NO. TOTAL