1982, 10-04 Permit: 82A-9046 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
1
JOB ADDRESS 130 4/ A dies
LOT BLOCK (SUBDIVISION
2
3.
OWNER
ADDRESS
CONTRAC
4. ADDRESS
PHONE
ZIP
LEGAL DESCRIPTION - SEE ATTACHED
PARCEL NUMBER /S
PHONE
Actual Set Backs in Feet
North South East West
Size of Parcel
Type Const.
Sprinklered
❑Yes ❑No ❑ Req'd.
Building Area in Sq. Ft.
ZIP
Main Floor
Garage Area
CHANGE OF USE FROM
6.
TYPE
7. OF
WORK
NEW
TO
Area of Decks
Finished Basement Unfin. Basemen
❑ ALT.
BLD. ❑ PLMB.
9.
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 pres me
to give authority to violate or cancel the provisions of any other state or local law re ;:. lating construction . the
performance of construction. SEE REVER E SIDE FOR REQUIRED INSPECTIONS
/
❑ AD'N.
❑ MECH.
DESCRIBE WORKa 't(e�
VALUATION SOURCE GAS
OF
UTILITIES
❑ RPL.
❑ M.H.
❑ MVE.
❑ POOL
❑ OTHER
No. Baths
No. Stories
No. Rooms No. of Dwellings
ELECTRIC
WATER
SEWER
CERTIFICATE
of EXEMPTION
Enum. Dist. I Location (Area)
Req'd.
Ownership
Public ❑ Private ❑
USE CODE
DATE OF APPLICATION
SIGNATURE OF APPLICANT
SPECIAL APPROVALS
NAME DATE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examine
SEPA Checklist
SPECIAL CONDITIONS:
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
Rec'd.
Not Req'd.
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify) L�
TOTAL $ r r
PERMIT NUMBER
- 64
03* *49.00
*49.006
A *0.00
904.52
10 -04 -82
6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
101 04' -82, 9046
DATE ISSUED
*49,00°
PERMIT NO. TC s ,