1981, 05-05 Permit: 81A-4322 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
JOB ADDRESS
2.
6.
LO T
BLOCK
OWNER
ADDRESS
CONTR .r.,/ OR A
SUBDIVISION
PHONE
ZIP
ADORE ���
DESIGNER
ADDRESS
CHANGE OF USE FROM
4_# r'S.
TO
PHONE
PHONE
ZIP
LEGAL DESCRIPTION - SEE ATTACHED
PARCEL NUMBER /S
Actual Set Backs in Feet
North South
Size of Parcel
TYPE
7, OF
WORK
`[J NEW 1: ALT.
/❑ BLD.LMB.
❑ AD'N.
❑ MECH.
❑ RPL.
❑ M.H.
❑ MVE.
❑ POOL
❑ OTHER
DESCRIBE WORK
VALUATION
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 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 INSPECTION
41
SOURCE
OF
UTILITIES
f? 7va'I"1
GAS
ELECTRIC
WATER
SEWER
Type Const.
Occupancy
East West
Valuation
Main Floor
Upper Floors
Area of Decks
No. Baths
Zone Classification
Sprinklered
Oyes LINO ❑ Req'd.
Building Area in Sq. Ft.
Garage Area
Finished Basement
No. Stories
CERTIFICATE
of EXEMPTION
Enum. Dist.
Storage
Unfin. Basement
No. Rooms
Req'd.
No. of Dwellings
Rec'd. Not Req'd.
Location (Area)
Ownership
Public ❑ Private ❑
USE CODE
DATE OF APPLICATION � SIGNATURE OF APPLICANT
SPECIAL APPROVALS
NAME DATE
Env. Healt h
Planning
Fire Marsh all
Co. Engineer
Utilities
Plans Exarnine
SEPA Checklist
Building echnician
SPECIAL CONDITIONS:
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL $
-Y/
PERMIT NUMBER
B i4
03* *41,00
* 41,00
* 41,006
A *000
431.72
05 -05 -81
g 6479.
431.7g 44 -GQ -499-,6
0',-)-O
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
0 5 -8,1
DATE ISSUED
432,22 *41000
PERMIT NO.
T07AL