1980, 11-07 Permit: 80B-3415 Plumbing FixturesPLAN NUMBER
f
APPLICATION /PERMIT
SPOKANE COUNTY - BUILDING CODES DEPARTMENT
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456 -3675
APPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE COPIES
JOB ADDRESS
1.
LOT
2.
BLOCK
Ai/ /e9/ f
SUBDIVISION
LEGAL DESCRIPTION - SEE ATTACHED
3
4.
J. ADDRES
OWNER
PHONE
PARCEL NUMBER /S
ADDRESS
CONT1i1TO7
I/ l/
ADQi!ESS
TO
�E5t6,
C
ZI P
Actual Set Backs in Feet
North 'South East (West
7)",-07
CHANGE OF USE FROM
6.
TYPE
7. OF
WORK
Z 171
PHONE.
ZI
Size of Parcel Zone Classification
Type Const.
Occupancy Sprinklered
❑Yes ❑No ❑ Req'd.
Valuation
Building Area in Sq. Ft.
Main Floor
Upper Floors
Garage Area
Storage
Area of Decks
Finished Basement
Unfin. Basement
EW ❑ ALT.
❑ BLD.
❑ AD'N. ❑ RPL. ❑ MVE.
MB. ❑ MECH. ❑ M.H. ❑ POOL
DESCRIBE WORK
8.
VALUATION
9.
SOURCE
OF
UTILITIES
El OTHER
No. Baths
No. Stories
No. Rooms
No. of Dwellings
CERTIFICATE
of EXEMPTION
Enum. Dist. I Location (Area)
Req'd.
Rec'd.
Not Req'd.
GAS 1 ELECTRIC
WATER
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 re. g 'g const ion oyjthe
performance of construction. SEE REV RSE SIDE FOR REQUIRED INSPECTIONS
DATE OF APPLICATION
SIGNATURE OF APPLICANT
SPECIAL APPROVALS
NAME DATE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
SPECIAL CONDITIONS:
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
FEES COLLECTED
Single $
Building )c-
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify))
TOTAL
9
PERMIT NUMBER
a) i.3— 3.4/6
03* *30,00
*30.00 N
*30.006
A *0,00 8
341.42
11 -07 -80
2 6479,
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
15 Z
DATE ISSUE. -�'8 �I PERMIT NO.