1981, 04-01 Permit: 81A-2936 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
1. E /g 1//7 "FA ard
LEGAL DESCRIPTION — SEE ATTACHED
LOT
BLOCK
SUBDI V ISIO
2.
OWNER �!
3.
4.
PARCEL NUMBER /S
PHONE
ADDRESS
CONTRACTOR „of
CV' 1+0 i9t— Re i4' #d 44
ZIP
Actual Set Backs in Feet
North 'South East 'West
PHONE
Size of Parcel
Zone Classification
ADDRESS
/32'3 Rue rs�-
Z If .
Type Const.
Occupancy
Sprinklered
❑Yes ❑No ❑ Req'd.
DESIGNER
5' ADDRESS
PHONE
Valuation (Building Area in Sq. Ft.
ZIP
Main Floor
Upper Floors I Garage Area
Storage
CHANG E OF USE FROM
6.
TYPE
7. OF
WORK
TO
Area of Decks
Finished Basement
Unfin. Basement
❑ ALT. ❑ AD N. ❑ RPL. ❑ MVE.
El BLD.PLMB. ❑ MECH. ❑ M.H. ❑ POOL
❑ OTHER
No. Baths
No. Stories
No. Rooms
No. of Dwellings
DESCRI BE WORK
8.
CERTIFICATE
of EXEMPTION
Enum. Dist. I Location (Area)
Req'd.
Rec'd.
Not Req'd.
VALUATION
9.
SOURCE
OF
UTILITIES
GAS
ELECTRIC
WATER
SEWER
Ownership
Public ❑ Private ❑
USE CODE
1 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 regu ng c. struction or the
performance of construction. SEE R EVERSE SIDE FOR REQUIRED INSPECTION
DATE OF APPLICATION # " ! / e.
SIGNATURE OF APPLICANT
SPECIAL APPROVALS SPECIAL CONDITIONS:
NAME. DATE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
Building Technician
4---/ -el dK-
PERMIT IS NONTRANSFERABLE
FEES COLLECTED
Single $
Building
�ei
Plumbing ;
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL
p
PERMIT NUMBER
03* *4500
*45.00 5
*45.006
A *0.00
293.52
04 -01 -81
z 6479,
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
0 - 'S`.1 2936Z *45.00x0 "T-
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE DATE ISSUED
PERMIT NO. TOTAL