1980, 09-08 Permit: 80-9787 Plumbing FixturesPLAN NUMBER
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
1.
2.
3
4.
JOB ADDRESS
OT
S, It !O i l� [ID rt r�t.9 I)
L BLC SU IVISION
LEGAL DESCRIPTION — SEE ATTACHED
5.
OWNER
j v 1� I°
ADDRESS
S ig► �I (Z-(2 ,4. Do,
CONTRACTOR
LL 4 i`3 i N (9
ADDRESS
S33 rt (1114 S Co'a I:4%A�115
DESIGNER
PHONE 0 ti.q
ZIP
PARCEL NUMBER /S
Actual Set Backs in Feet
North 'South [East 'West
PHONE
Size of Parcel l Zone Classification
ZI P
g art
Type Const.
Occupancy
Sprinklered
❑Yes ❑NO ❑ Req'd.
PHONE
Valuation (Building Area in Sq. Ft.
ADDRESS
ZIP
Main Floor I Upper Floors ( Garage Area
Storage
CHANGE OF USE FROM
6.
TYPE
7, OF
WORK
TO
Area of Decks
Finished Basement
Unfin. Basement
❑ NEW ❑ ALT. l AD'N. ❑ RPL. ❑ MVE.
❑ BLD. ❑ PLMB. ❑ MECH. ❑ M.H. ❑ POOL
❑ OTHER
No. Baths
No. Stories
No. Rooms
No. of Dwellings
CERTIFICATE
of EXEMPTION
Req'd.
Rec'd.
Not Req'd.
DESCRIBE WORK
8. �'4t�M ,niC� It
VALUATION SOURCE GAS
OF
Enum. Dist. I Location (Area)
9. UTILITIES
ELECTRIC
ATE R
SEWER
Ownership
Public ❑ Private ❑
USE CODE
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 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 gig/ X {L SIGNATURE OF APPLICAN
SPECIAL APPROVALS SPECIAL CONDITIONS:
NAME DATE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examine-
SEPA Checklist
Bu ding TecIhnicia
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
FEES COLLECTED
Single $
Building 1�{
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL $
PERMIT NUMBER
6 4 ) - 9 7 - 7
03* *1300
*13,00 to-
* 1 3006
A *000
97862
09 -08 -80
z 6479,
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
0 9 „- ,0,g.-8' O
DATE ISSUED
978.72 *13,00 °1=1
PERMIT NO. TOTAL