1980, 11-07 Permit: 80B-3417 Plumbing FixturesPLAN NUMBER
APPLICATION /PERMIT
SPOKANE COUNTY - BUILDING CODES DEPARTMENT
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456 -3675
JOB ADDRESS
LOT
/(
,,APPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 3 COPIES
SUBDIVISION
3.
OWNER
PHONE
LEGAL DESCRIPTION - SEE ATTACHED
PARCEL NUMBER /S
ADDRESS
CONTRACT /
O9E %
9
4. ADD ESS
5. ADD
6.
ZIP
Actual Set Backs in Feet
North 'South
Size of Parcel
Type Const.
Occupancy
Valuation
t 9 I / 1� C
CHANGE OF USE FROM TO
Z� z/
Main Floor
East
Ga
West
Zone Classification
Sprinklered
❑Yes ❑No ❑ Req'd.
Building Area in Sq. Ft.
Upper Floors rage Area
Area of Decks
Finished Basement
TYPE
7. OF
WORK
EW ❑J ALT. ❑ AD'N. ❑ RPL.
❑ BLD. LMB. ❑ MECH. ❑ M.H.
❑ MVE.
❑ POOL
❑ OTHER
No. Baths
No. Stories
No. Rooms
Storage
Unfin. Basement
No. of Dwellings
CERTIFICATE
of EXEMPTION
Req'd.
Rec'd.
Not Req'd.
DESCRIBE WORK
VALUATION
9.
SOURCE
OF
UTILITIES
GAS
I ELECTRIC TER
Enum. Dist. I Location (Area)
1
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 •• .'t does not presume
to give authority to violate or cancel the provisions of any other state or local law re . co. u•tion r the
performance of construction. SEE ' EVERSE SIDE FOR REQUIRED INSPECTIONS
DATE OF APPLICATION
SIGNATURE OF APPLICANT
SPECIAL APPROVALS
! NAME DATE
Env. Health
Planning•'rr
Fire Marshall
Co. Engineer
Utilities
Plans Examine
SEPA Checklist
SPECIAL CONDITIONS:
PERMIT IS NONTRANSFERABLE
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL
PERMIT NUMBER
:d L3 -39/ 7
03* *3000
*3000
*30,008
A *000
341.62
11 -07 -80
6.479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
1.11 -8 1:10 14171 *3'4'00 TO
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE DATE ISSUED PERMIT NO. TOTAL