1983, 12-28 Permit 84A-935 Gas PipingPLAN NUMBER
PERMIT NUMBER
0%3E3- iZ71;'
APPLICATION/PERMIT
SPOKANE COUNTY — BUILDING CODES DEPARTMENT
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 3 COPIES
JOB ADDRESS ' //4.. /�
C-,/� » r - 7L/
LOT BLOC SUBDIVISION
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OWNER
AESS
/%lei'/
CONTRACTOR
4. `��✓ /cam C` a/ (IC3
ADORES
'/ c 41.
DESIGNER
ADDRESS /
CHANGE OF USE FROM
6.
PHONE
/f f''7
ZI P
PHONE
ZIP
PHONE
LEGAL DESCRIPTION - SEE ATTACHED
PARCEL NUMBER/S
Actual Set Backs in Feet
North (South East 'West
Size of Parcel Zone Classification
Type Const.
Valuation
Occupancy
Sprinklered
❑Yes ❑No ❑ Req'd.
Building Area in Sq. Ft.
ZI P
Main Floor
Upper Floors
Garage Area
Storage
TO
Area of Decks
Finished Basemen
Unfin. Basement
TYPE
7, OF
WORK
/KNEW El ALT. ❑ AD'N. ❑ RPL. ❑ MVE.
❑ BLD. ❑ PLMB. ❑ MECH. ❑ M.H. ❑ POOL
RIBE WORK
9.
G Lea
ALUATION
❑ OTHER
No. Baths
No. Stories
No. Rooms
No. of Dwellings
CERTIFICATE
of EXEMPTION
Enum. Dist. I Location (Area)
Req'd.
SOURCE
OF
UTILITIES
GAS
ELECTRIC
TE R
SEWER
Ownership
Public 0 Private 0
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 =?l/} SIGNATURE OF APPLICANT C-1L✓<<-Ce.
SPECIAL APPROVALS
NAME DATE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklis
SPECIAL CONDITIONS:
Rec'd.
Not Req'd.
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTA L
04* *12.00
* 1 2.006
R *0,00
281,52
12-28-83
6479,
—
u
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATF nF IRRi orurc
._
12,2.8-83 2-814g *1i2_0-aah -