1980, 10-02 Permit: P80B-1304 Plumbing FixturesPLAN NUMBER
JJ
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
2.
OWNER
3
BLOCK
SUBDIVISION
LEGAL DESCRIPTION - SEE ATTACHED
PARCEL NUMBER /S
PHONE
ADDRESS
ZI P
CO N T F;A,GO
Of/
4. �//��VVJJ (( / // iC7 L2
DESIGNEp
5.
AD
CHANGE OF USE FROM
6.
TYPE
7. OF
WORK
P ONE
-gib "
ZIP
PHONE
Actual Set Backs in Feet
North 'South East 'West
Size of Parcel Zone Classification
Type Const.
Occupancy Sprinklered
❑Yes ❑NO ❑ Req'd.
Valuation
Building Area in Sq. Ft.
TO
ZIP _
iy /Gy x
Main Floor
Upper Floors
Garage Area
Storage
Area of Decks
Finished Basement
Unfin. Basement
W ❑ ALT. ❑ AD'N.
.LMB. ❑ MECH.
❑ BLD.
DESCRIBE WORK
8.
❑ RPL.
❑ M.H.
❑ MVE.
❑ POOL
// , JKAure-
El OTHER
No. Baths
No. Stories
No. Rooms
No. of Dwellings
CERTIFICATE
of EXEMPTION
Req'd.
Rec'd.
Not Req'd.
Enum. Dist.
Location (Area)
VALUATION
9.
SOURCE
OF
UTILITIES
GAS
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 gul.ting construction or the
performance of construction. SEE REVERSE SIDE FOR REQUIRED INSPECTION
DATE OF APPLICATION SIGNATURE OF APPLICANT r
SPECIAL APPROVALS
NAME DATE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
B ilding T hnici
SPECIAL CONDITIONS:
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 $ 6-
PERIv?IT NJM3ER
03* *3050
*3050
*30,506
A *0,00
13Q3g
10 -02 -80
6479,
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
1.0- 02`8'0', 13a4'z *30.'50
DATE ISSUED PERMIT NO. TOTAL