1980, 05-14 Permit: 80-4734 Plumbing FixturesLAN 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 4 COPIES
JOB ADDR ESS
/ y eFa /-211.41
LOT
BLOCK
SUBDIVISION
OWNR —
3. E
. 5'�Uc P //,5'
ADDRESS
4.
of '
CONTRACTOR
PHONE
.3;7,7-83e/
ZI P
PHONE
87--Je
ADDRESS
DESIGNEFL
5. ADDRESS
CHANGE OF USE FROM
6.
TYPE
7. OF
WORK
O NEW
BLD.
❑ ALT.
❑ PLMB.
ZIP
PHONE
ZIP
TO
❑ AD'N.
❑ MECH:
❑ RPL.
❑ M.H.
❑ MVE.
❑ POOL
El OTHER
LEGAL DESCRIPTION - SEE ATTACHED
PARCEL NUMBER /S
Required Set Backs in Fee
North
South East
Size of Parcel
Type Const.
Occupancy
West
Zone Classification
Valuation
DWL Area
Basement Area Garage Area
Split Entry
No. Baths
Split Level
No. Floors
CERTIFICATE
of EXEMPTION
DESCRIBE WORK
VALUATION
9.
Source 7 GAS
of
Utilities
ELECTRIC
WATER
Sprinklered
❑Yes ENo ❑ Req'd.
Building Area in Sq. Ft.
Storage
Rancher
No. Rooms
SEWER
I hereby certi fy that I have read and examined this application and have read the "NOTICE" provisions included
on reverse sid e, 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.
DATE " So SIGNATURE
Req'd.
SPECIAL APPROVALS
DEPT. REQ'D. REC'D.
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Zone Clearance
SEPA Checklist
SPECIAL CONDITIONS:
DATE
OFFICIAL /2424) g l�
APPROVED FOR ISSUANCE
Rec. Room
Rec'd.
Not Req'd.
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL
PERMIT NUMBER
DATE —/# —ge
63* *118.00
*48.00
*48.00'6
E *0.00
473.3-2
05 -14 -80
6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS. COMESRMIT.
[�- 14,,A E- 0 47'3,45 *48.00°
DATE REMARKS
RECORD OF INSPECTIONS
Final Inspection
INSPECTED BY
*00C o
VSUU
^24 4'4800