1980, 06-03 Permit: P-80-5303 Plumbing Fixtures,PLAN NUMBER
L.
APPLICATION /PERMIT
SPOKANE COUNTY - BUILDING CODES DEPARTMENT
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456 -3675
APPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 4 COPIES
1.
2.
JOB ADDRESS
loo
12,1 ,4 71/ i f_ s
LOT BLOCK SUBDIVISION
LEGAL DESCRIPTION - SEE ATTACHED
OWNE
3, C A» /P/ if
ADDRESS 1/ ` //4
�� z :,2I/ % t k .q �Er
CONTRACTOR
ADDRE
i< 7 ,✓e
DESIGNER
5' ADDRESS
PHONE
IP
PARCEL NUMBER /S
Required Set Backs in Feet
North (South 'East (West
PHONE
73� $ '*2f
ZIP,
Size of Parcel
Zone Classification
Type Const.
Occupancy
Sprinklered
❑Yes ❑No ❑ Req'd.
PHONE
Valuation
Building Area in Sq. Ft.
ZI P
DWL Area I Basement Area
Garage Area Storage
CHANGE OF USE FROM
6.
TYPE
7. OF
WORK
TO
Split Entry
Split Level
Rancher
La°NEW ❑ ALT. ❑ AD'N. ❑ RPL. ❑ MVE.
❑ BLD. LMB. ❑ MECH: ❑ M.H. ❑ POOL
❑ OTHER
No. Baths
No. Floors
No. Rooms
Rec. Room
CERTIFICATE
of EXEMPTION
Req'd.
Rec'd.
Not Req'd.
DESCRIBE WORK
8.
VALUATION
9.
Source
of
Utilities
GAS
ELECTRIC WAT
SEWER
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 or the
performance of construction.
DATE SIGNATURE
SPECIAL APPROVALS
DEPT. REQ'D. REC'D.
4
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Zone Clearance
SEPA Checklist
SPECIAL CONDITIONS:
DATE(-3 OFFICIAL
APPROVED FOR ISSUANCE
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL
$
DATE
PERMIT NUMBER
P-560-5 f.Y3
03* *25.50
*2550 to-
* 25.506
E *000
530,2
06 -03 -80
2 6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THISJBECOMES j.,PERMIT.
D TC 0 31- 8" 0 5 '3 O. 3 5
*25.50a�
U
W
DATE
RECORD OF INSPECTIONS
REMARKS
4.
M
Final Inspection
INSPECTED BY