1980, 11-24 Permit: P80B-4141 Plumbing Fixtures!PLAN 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 BLO K
OWNER
ADDRESS
CONTRA
SUBDIVISION` - - t/
PHONE
ZIP
PHONE
LEGAL DESCRIPTION — SEE ATTACHED
PARCEL NUMBER /S
Actual Set Backs in Feet
North South
Size of Parcel
D ft ESS
/32 6 _3 �G►�fiC E�
DESIGNER
J. ADDRESS
CHANGE OF USE FROM
6.
TYPE
7. OF
WORK
ZIP
PHONE
ZIP
TO
ta-N-EW ❑ ALT. ❑ AD'N. ❑ RPL. ❑ MVE.
❑ BLD. -gYPLMB. ❑ MECH. ❑ M.H. ❑ POOL
❑ OTHER
DESCRIBE WORK
0
VALUATION
9.
SOURCE
OF
UTILITIES
G
''ELECTRIC
Type Const.
Occupancy
Valuation
Main Floor
Sprinklered
❑Yes ❑No ❑ Req'd.
Building Area in Sq. Ft.
Upper Floors Garage Area
Storage
Area of Decks
No. Baths
Finished Basement
Unfin. Basement
No. Stories
No. Rooms
No. of Dwellings
CERTIFICATE
of EXEMPTION
Enum. Dist.
Req'd.
Rec'd.
Not Req'd.
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 SIGNATURE OF APPLICANT
SPECIAL APPROVALS
NAME DATE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
SPECIAL CONDITIONS:
c
�? Vic/ U,
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
Cis
TOTAL $ O..'q
1
PERMIT NUMBER
03* *53.00
*53.00
*53.006
A *000 g
414,02
11 -24 -80
R. 6479,
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATE ISSUED
43412 *53.00 0 �
PERMIT NO. TOTAL