1980, 11-07 Permit: P80B-3425 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.
JOB ADDRESS
LOT BLOCK
OWNER
ADDRESS
Ai, / /a ! r
SUBDIVISION'
CONTRACCyrC I/
D
SS
PHONE
ZIP
5. P-
ADD RVSp,-,
6.
CHANGE OF USE FROM
TYPE
7. OF
WOR K
17()x''
TO
71, itg7
ZIP
ZIP
rl
LEGAL DESCRIPTION — SEE ATTACHED
PARCEL NUMBER /S
Actual Set Backs in Feet
North !South
East
West
Size of Parcel
Type Const. Occupancy
Zone Classification
Sprinklered
❑Yes ❑No ❑ Req'd.
Valuation
Main Floor
Building Area in Sq. Ft.
Upper Floors Garage Area
Area of Decks
Storage
Finished Basement Unfin. Basemen
NEW ❑ ALT. ❑ AD'N. ❑ RPL.
MB. ❑ MECH. ❑ M.H.
❑ BLD.
❑ MVE.
❑ POOL
❑ OTHER
No. Baths No. Stories
DESCRIBE WORK
VALUATION
9.
SOURCE
OF
UTILITIES
GAS
ELECTRIC
WATER
SEWER
CERTIFICATE
of EXEMPTION
Enum. Dist.
No. Rooms
Req'd.
'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 re ion or the
performance of construction. SEE REVERSE SIDE FOR REQUIRED INSPECTIONS
DATE OF APPLICATION
SPECIAL APPROVALS
NAME DATE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
ician
SIGNATURE OF APPLICANT
SPECIAL CONDITIONS:
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
FEES COLLECTED
Single $
Building
Plumbing . F 4"
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL $/
I, •
'2MIl NUMBER
03* *30,00
*30.00
*30,008
A *0.00 e
302L�
11 -07 -80
6,479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
1'1;- o x'8!0
DATE ISSUED
PERMIT3N6. 5 g, *lap O4 Le