1980, 11-24 Permit: P80B-4139 Plumbing Fixtures(PLAN NUMBER
INN
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
1.
2.
3.
4.
JOB ADDRESS
i
K% B& I O N �,c .l�� et. �'
BLOCK SUBDIVISION
LOT
OWNER •
1)
ADDRESS
CONTRA O :Jy f
AD RESS
DESIGNER
5. ADDRESS
CHANGE OF USE FROM
6.
TO
PHONE
ZI P
PHONEq
w,-3
ZIP
PHONE
LEGAL DESCRIPTION - SEE ATTACHED
PARCEL NUMBER /S
Actual Set Backs in Feet
North 'South
Size of Parcel
East (West
Zone Classification
Type Const.
Occupancy
ZIP
Valuation
Sprinklered
❑Yes ❑No ❑ Req'd.
Building Area in Sq. Ft.
Main Floor I Upper Floors r Garage Area
PERMIT NUMBER
g* J .—/
03* *53,00
*53.00
*53.006
A *0.00
41382
11 -24 -80
2 6479,
Storage _
Area of Decks
Finished Basement
Unfin. Basement
TYPE
7. OF
WORK
W ❑ ALT. ❑ AD'N. ❑ RPL. ❑ MVE.
❑ BLD. ❑ MECH. ❑ M.H. ❑ POOL
❑ OTHER
No. Baths
No. Stories
No. Rooms
No. of Dwellings
CERTIFICATE
of EXEMPTION
Req'd.
DESCRIBE WORK
8.
VALUATION
9.
SOURCE
OF
UTILITIES
G
ELECTRIC
Enum. Dist. I Location (Area)
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 regulating construction or the
performance of construction. SEE REVERSE SIDE FOR REQUIRED INSPECTIONS
DATE OF APPLICATION 1 / /4 SIGNATURE OF APPLICANT
SPECIAL APPROVALS SPECIAL CONDITIONS:
NAME DATE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
ZyW
z�c�.,
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
Rec'd.
Not Req'd.
FEES COLLECTED
Single $
Building
Zri
Plumbing
o
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL $ v��
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATE ISSUED
41395 *53,00a�
PERMIT NO.