1982, 11-03 Permit: 82B-0514 Plumbing FixturesPLAN NUMBER
APPLICAT.ON /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 ADDRESS ,
LOT
C1 V�
BLOCK SUBDIV SION
LEGAL DESCRIPTION - SEE ATTACHED
OWNER
PHONE
PARCEL NUMBER /S
ADDRESS
CONTR CTp
/00 It (Criticith•Leberkj
4. AD4 Ec7 ,11/ �T l�Y
DES N R
f
5. l /C $ Ft U 1-A- 1! ,1le�
AD ESS
O . as. ` '71
CHANGE OF USE FROM
6.
TYPE
7. OF
WORK
ZI P
Actual Set Backs in Feet
North (South [East 'West
PHONE
Size of Parcel 1 Zone Classification
ZIP
Type Const.
Occupancy
Sprinklered
❑Yes ❑No ❑ Req'd.
PH ON.W h) '1/
Z122.9, 6
Valuation (Building Area in Sq. Ft.
Main Floor
Upper Floors 1 Garage Area
Storage
TO
Area of Decks
Finished Basement
Unfin. Basement
NEW ❑ ALT. ❑ AD'N. ❑ RPL. ❑ MVE.
❑ OTHER
BLD. PLMB. ❑ MECH. ❑ M.H. ❑ POOL
No. Baths
No. Stories
No. Rooms
No. of Dwellings
DESCRIBE WORK
8.
VALUATION
9.
SOURCE
OF
UTILITIES
GAS/
CERTIFICATE
of EXEMPTION
Enum. Dist. `Location (Area)
Req'd.
Rec'd.
Not Req'd.
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 regulating constructi or the
performance of construction. SEE REVERSE SIDE FOR REQUIRED INSPECTIO
DATE OF APPLICATION
SIGNATURE OF APPLICANT
SPE1..IAL APPROVALS SPECIAL CONDITIONS:
NAME DATE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL
LErce
$
a
PERMIT NUMBER
03* *49.00
*49.006
A *000
51.38
'11 -03 -82
6,479,
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
0 3 =8`2
DATE ISSUED
5 1. 4
PERMIT NO.
ci Z *490 0 aI
TOTAL