1980, 11-07 Permit: P80B-3419 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
3
4.
5.
ADD SS
JOB ADDRESS
LOT
OWNER
ADDRESS LL
CONTRA T
BLOCK
/3c7 4
SUBDIVISION
i C 5
PHONE
ZI P
AD. RESS
5
r
LL
LEGAL DESCRIPTION - SEE ATTACHED
PARCEL NUMBER /S
Actual Set Backs in Feet
North South
Size of Parcel
Valuation
6.
Occupancy
Sprinklered
❑Yes ❑No ❑ Req'd.
Building Area in Sq. Ft.
Main Floor
Upper Floors
Garage Area
Storage
CHANGE OF USE FROM
TYPE
7. OF
WORK
TO
J2c`f4EW ❑ ALT. ❑ AD'N. ❑ RPL. ❑ MVE.
❑ BLD.PLMB. ❑ MECH. ❑ M.H. ❑ POOL
❑ OTHER
DESCRIBE WORK
VALUATI ON
9.
SOURCE
OF
UTILITIES
GAS
ELECTRIC
WATER
SEWER
Area of Decks
No. Baths
Finished Basement
Unfin. Basement
No. Stories No. Rooms No. of Dwellings
CERTIFICATE
of EXEMPTION
Req'd. Rec'd.
Not Req'd.
Enum. Dist.
Location (Area)
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 ,Q!Li ating constructio or the
performance of construction. SEE REVERSE SIDE FOR REQUIRED INSPECTIO
SIGNATURE OF APPLICANT Aar
DATE OF APPLICATION / 0 7 g 5 . 9 4SC/
SPECIAL APPROVALS
NA,'E DATE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
SPECIAL CONDITIONS:
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
FEES COLLECTED
Single $
Building
Plumbing L7Z91"
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL $ 4
li RMI'i NUMBER
03* *3000
*3000 N
*30.006
A *0.00
341.82
11 -07 -80
z 6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
111 ;0 7,- 810 3,419g *30.00?.
DATE ISSUED
PERMIT NO.