1982, 10-04 Permit: 82A-9048 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
JOB ADDRESS
1.
LOT BLOCK SU�DIVISIu,'i
2.
LEGAL DESCRIPTION - SEE ATTACHED
3.
OWNER
PHONE
PARCEL NUMBER /S
ADDRESS
CONTRACTOR %
4- ADDRE
Vectt-
DESIGNE
�
s. C �S 1.4I t . L7,
ADD Rl ('
3 7/
CHANGE OF USE FROM
6.
TO
ZIP
Actual Set Backs in Feet
North 'South [East (West
PHONE
Size of Parcel I Zone Classification
ZIP ,
Type Const.
Occupancy
Sprinklered
❑Yes ❑No ❑ Req'd.
PR-C71#
C71#
ZI P
Valuation (Building Area in Sq. Ft.
Main Floor
Upper Floors Garage Area
Storage
Area of Decks
Finished Basement
Unfin. Basement
TYPE
7. OF
WORK
NEW ❑ ALT. ❑ AD'N. ❑ RPL. ❑ MVE.
❑ OTHER
BLD. ❑ PLMB. ❑ MECH. ❑ M.H. ❑ POOL
No. Baths
No. Stories
No. Rooms
No. of Dwellings
DESCRIBE WOR
8.
VALUATION
9.
SOURCE
OF
UTILITIES
GAS
CERTIFICATE
of EXEMPTION
Enum. Dist. I 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 construction o he
performance of construction. SEE REVER E SIDE FOR REQUIRED INSPECTIONS
DATE OF APPLICATION
I I1-1" SIGNATURE OF APPLICANT
SPECIAL APPROVALS
NAME DATE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
Build i • Te n'cia
SPECIAL CONDITIONS:
PERMIT IS NONTRANSFERABLE
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
CL
TOTAL $
PERMIT NUMBER �Jp
A':_'" "141
03* *49.00
*49.006
A *0.00
9047°
10 -04 -82
2 6479
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
10 0 4.-12
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE DATE ISSUED
90482
PERMIT NO.
*49.00a17-1
TOTAL