1980, 09-15 Permit: P80B-0192 Plumbing Fixtures(PLAN 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
JOB AC
LOT
o R's j 13 Ali I A{ %
BLOC /(
ADDRESS
4.
CON�RACR_
LEGAL DESCRIPTION - SEE ATTACHED
SUBDIVISION
PHONE
-
�
53
kik- \ ° G\ i K0-1 I LA9 UU "r'.› HOO
PHONE
PARCEL NUMBER /S
Actual Set Backs in Feet
North (South
East
'West
Size of Parcel
Zone Classification
ADDRESS
ZIP
Type Const.
Occupancy
Sprinklered
Lives ❑No ❑ Req'd.
5.
DESIGNER
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
Ild NEW ❑, /ALT. ❑ AD N. ❑ RPL.
U7 PLMB. ❑ MECH. ❑ M.H.
❑ BLD.
Area of Decks
Finished Basement
Unfin. Basement
❑ MVE.
❑ POOL
❑ OTHER
No. Baths
No. Stories
CERTIFICATE
of EXEMPTION
No. Rooms
No. of Dwellings
Req'd.
Rec'd.
Not Req'd.
8.
9.
DESCRIB WORK
V 11 Nc
VALUAT ON
SOURCE
OF
UTILITIES
9
AS
six -rJF )
ELECTRIC
Enum. Dist. I Location (Area)
WATE R
SEWER
Ownership
Public ❑ Private ❑
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 INSPEC O.
DATE OF APPLICATION `.�7 - / •4'
FEES COLLECTED
Single $
Building
Plumbing
SIGNATURE OF APPLICAN
SPECIAL APPROVALS
NAME DATE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
ildin�q Tech i
1
SPECIAL CONDITIONS:
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
SEPA
Mobile Home
Other (Specify)
TOTAL $
PERMIT NUMBER
3 2J "
03* *2550
*25,50
*25,50
A *Q00 8
19.12
09 -15 -80
2 6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
'0 9 -15` - 810'
DATE ISSUED
19.2° *25.510 —
TOTAL
PERMIT NO.