1983, 11-28 Permit 83B-2068 Wtr Htr(PLAN NUMBER
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SPOKANE COUNTY — DEPARTMENT OF BUILDING & SAFETY
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
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APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
1.
STREET ADDRESS
.
LOT
2.
BLOCK
SUBDIVISION
OWNER
3. KA`/� v►��►4
Mg,IN4G ADDRESS
CONTRACTOR
4. t� vC
ADDRESS
?I'� F•M �
DESIGNER
PHONE
LICENSE EXPIRES
PHONE
ADDRESS
CHANGE OF USE FROM
•
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Ciac4
PHONE
ZIP
PHONE
ZIP
TO
TYPE C'NEW ❑ ALT. ❑ AD'N. ❑ RPL. ❑ MVE.
7. OF ❑ OTHER
WORK 0 BLD. 2(PLMB. ❑ MECH. 0 M.H. IDPOOL
DESCRIBE WORK
8. iti ti�TE2 E • -rt _ G � w +vc�,
PARCEL NO.
LEGAL DESCRIPTION:
Actual Set Backs in Feet to:
North South East West
Size of Parcel
Type Const.
New Const. Valuation
Main Floor
Zone Classification
Residential ❑
Commercial ❑
Spr'nklered
❑Yes ❑No ❑Req'd.
Remodeled Valuation
Upper Floors
Cover Deck
VALUATION SOURCEOGAS
9• OF
ELECTRIC
WATER
PUBLIC 0
PRIVATE 0
SEWAGE
SEPTIC 0
SEWER ❑
No. Baths
Certifi. of Exempt.
or Variance
Garage/Storage
Uncv. Deck
No. Floors
Shorelines/Flood Hazard
Yes❑ Not Applic. ❑
Ownership
Public 0 Private 0
Total Bldg. Floor Area
Greenhouse
Fin. Basement
No. Fin. Rooms
Required Yes El No❑
Received Yes❑ Noi l
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 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 AGEN
APPLICATION �3
DATE
SPECIAL APPROVALS
PRELIM. FINAL DATE
Env. Health
planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
SPECIAL CONDITIc N : (SEE REVERSE SIDE FOR NOTICE)
PERMIT IS NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
Unfin. Basement
No. Dwellings
Plans Required 0
Received ❑
FEES COLLECTED
Building
Plumbing
Mech.
Plan Check
SEPA
Modular/
MFG. Home
Other (Specify)
TOTAL $ 1�c7C)
* 1600
* 16006
A *000
2067�
11-28-83
6.479,
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATE ISSk1LD' 2 8-8-3 PERMIT Nt.2 Q f6. 8
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