1979, 08-29 Permit: 79-3038 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 4 COPIES
1.
JOB ADDRESS
LOT
2.
OWNER
BLOCK
/ /7/1 /k,
SUBDIVISION
LEGAL DESCRIPTION - SEE ATTACHED
PARCEL NUMBER /S
3.
ADDRESS
PHONE
ZI P
4.
5.
CONTRACT71
ADDItS
t j 3366, //6.4
A"PT 26'9 K in/
CHANGE OF USE FROM O
6.
PHONE
ZIP
PHONE_
Required Set Backs in Feet
North (South East (West
Size of Parcel Zone Classification
Type Const.
Occupancy Sprinklered
❑Yes ❑No ❑ Req'd.
Valuation
ZIP
DWL Area I Basement Area
Building Area in Sq. Ft.
Garage Area ` Storage
Split Entry
Split Level
Rancher
TYPE
7. OF
WORK
NEW
❑ BLD.
❑ ALT.
❑ PLMB.
❑ AD'N.
❑ MECH:
❑ RPL.
❑ M.H.
❑ MVE.
❑ POOL
❑ OTHER
No. Baths
No. Floors
No. Rooms
Rec. Room
CERTIFICATE
of EXEMPTION
Req'd.
Recd.
Not Req'd.
DESCRIBE WORK
8.
X 71a re '3
9.
VALUATION
Source
of
Utilities
GAS
ELECTRIC
WATER
SEWER
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. Th• •r.•ting of a permit does not presume
to give authority to violate or cancel the provisions of any other state �..; law regulating construction or the
performance of construction.
DATE SIGNATURE
DEPT.
SPECIAL APPROVALS
REC'D_ REC'D.
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Zone Clearance
SEPA Checklist
SPECIAL DITIONS:
DATE
FOR ISSUANCE
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL $
DATE
PERMIT NUMBER
-79'3
03* *33.00
*33.00
*33.008
A *0.00
303.72
08 -29 -79
2 6,479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
08 -29 -79 303,'82 *33,002F2
RECORD OF INSPECTIONS
Final Inspection
REMARKS INSPECTED BY
Vtt.16
013-S6-Ad
4C0', 2
421005Z
*2200
fl 2#