1981, 01-19 Permit App: 81A-646 Gas PipingPLAN 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
JOB ADDRESS
LOT
L BLOC
SUBDIVISIO
3.
4.
OWN
ADDRESS
CONTRACTOR
of .
•
PHONE
E 2
:Al MIA0
LEGAL DESCRIPTION - SEE ATTACHED
PARCEL NUMBER /S
ZIP Actual Set Backs in Feet
North 'South 'East West
Zone Classification
PHONE
ADDRESS
CHANGE OF US FROM
6.
TYPE
7, OF
WORK
El NEW
❑ BLD.
❑ ALT.
❑ PLMB.
ZIP
PHONE
ZI P
TO
❑ AD'N.
( MECH.
❑ RPL.
❑ M.H.
❑ MVE.
❑ POOL
El OTHER
DESCRIBE WORK
8. i -- 4- 1, -,,J�- - a- ce -=�iu
VALUATION SOURCE
OF
9. UTILITIES
.,2' ( eO /C 6G
ELECTRIC
GAS
X
WATER
SEWER
Size of Parcel
Type Const.
Occupancy
Valuation
Main Floor
Upper Floors
Area of Decks
No. Baths
Garage Area
Finished Basement
No. Stories
CERTIFICATE
of EXEMPTION
Enum. Dist.
Sprinklered
❑Yes ❑No ❑ Req'd.
Building Area in Sq. Ft.
Storage
Unfin. Basement
No. Rooms No. of Dwellings
Location (Area)
Ownership
Public ❑ Private ❑
Req'd. Rec'd. Not Req'd.
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 / — il— / SIGNATURE OF APPLICANT "`
SPECIAL APPROVALS
NAME DATE
Env. Health
Planning
Fire Marsha"
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
Bui mg ech ician
SPECIAL CONDITIONS:
d PIPE
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
FEES COLLECTED
Single $
Building
Plumbing
Mech. i, r(I2
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL JO
PERMIT NUMBER
04* *1800
* 1800 N
* 18006
A *0.00
6&52
0'1 -19 -81
2 6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
014.. -81 64.68 *18,000.1-
PERMIT NO. 1-011, .-
DATE ISSUED