1983, 06-27 Permit 83A-5838 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
LOT BLOCK �SUBDIVISI'/ON
1.
2. 3 2�
PHONE
3.
MAILI G ADDRE
CONTR
4.
ADDRESS
• T•
JAN
LICENSE EXPIRES
ZIP
CO
PARCEL NO.
LEGAL DESCRIPTION:
Actual Set Backs in Feet to:
North South
Size of Parcel
East
West
Zone Classification
Type Const. Occupancy Sprinklered
❑Yes ❑No ❑Req'd.
Residential ❑
Commercial 0
DESIGNER
5.
ADDRESS
CHANGE OF USE FROM
•
TYPE NEW
7. OF
WORK 0 BLD.
PHONE
ZIP
New Const. Valuation
Remode ed Valuation
TO
❑ ALT. 0 AD'N. 0 RPL. 0 MVE.
LMB. 0 MECH. ❑ M.H. 0 POOL
8.
DESCRIBE WOR
VALUATION
9.
SOURCE
OF
UTILITIES
GAS
0 OTHER
Main Floor (Upper Floors (Garage/Storage
Cover Deck I Uncv. Deck
ELECTRIC
No. Baths
Certifi. of Exempt.
or Variance
No. Floors
Required
Received
ITotal Bldg. Floor Area
Greenhouse
Fin. Basement tUnfin. Basement
No. Fin. Rooms
Yes ❑
Yes 0
No❑
No El
No. Dwellings
Number
Shorelines/Flood Hazard
Yes Not Applic. ❑
WATER
PUBLIC 0
PRIVATE 0
SEWAGE
SEPTIC 0
SEWER 0
Ownership
Public 0 Private ❑
I hereby certify that I have read and examined this appl'cation 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 INSPECTIONS
SIGNATURE OF
OWNER OR AGENT
SPECIAL APPROVALS
PRELIM. FINAL DATE
Env. Health
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
APPLICATION
DATE
SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PERMIT IS NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
Plans Required ❑
Received 0
FEES COLLECTED
Building
Plumbing
Mech.
Plan Check
SEPA
Modular/
MFG. Home
Other (Specify)
TOTAL
PERMIT NUMBER
83 A 5838
03* *33.00
*33006
A *0.00
58372
06-27-83
-2 6479.
1
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATEYSSUED2 7 — 8 3
PERMIT IOo 3.8 Z
*33,00a1'2
TOTAL