1980, 12-02 Permit: 80B-4370 Plumbing FixturesFEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL $ r, �a,;*J
(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
3
LOT BLOC
OWNER
ADDRESS
SUBDIVISION
4.
CONTRA OR�a
ADDRESS
— &4'44 -t
DESIGNER
ADDRESS
CHANGE OF USE FROM
6.
TYPE
7. OF
WORK
PHONE
ZIP
PHONE
9.ecyvy2-.2,
ZIP
PHONE
ZIP
TO
LJ NEW ❑ ALT. ❑ AD'N. ❑ RPL. ❑ MVE.
❑ BLD. . PLMB. ❑ MECH. ❑ M.H. ❑ POOL
❑ OTHER
LEGAL DESCRIPTION - SEE ATTACHED
PARCEL NUMBER /S
Actual Set Backs in Feet
North (South
Size of Parcel
Type Const.
Valuation
Occupancy
Main Floor
East (West
Zone Classification
Sprinklered
❑Yes ❑No ❑ Req'd.
Building Area in Sq. Ft.
Garage Area
Upper Floors Storage
Area of Decks Finished Basement Unfin. Basement
No. Baths
No. Stories
No. Rooms
No. of Dwellings
DESCRIBE WORK
8.
VALUATION
9.
SOURCE
OF
UTILITIES
ELECTRIC WATER SEWER
CERTIFICATE
of EXEMPTION
Enum. Dist. I Location (Area)
Req'd.
Ownership
Public ❑ Private ❑
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 �^ ,/ 3 SIGNATURE OF APPLICANT
SPECIAL APPROVALS
NAME DATE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Plans
Examiner
SEPA Checklist
Building Te nic;
SPECIAL CONDITIONS:
:- -<
G
. 4-6.0 "!" V
1,
(..Lj
•
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
Rec'd.
Not Req'd.
PERMIT NUMBER
03* *2800
*2800 N
*28.006
A *0.00
4369z
12-02 -80
2 6.479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
12;021 -;?0
DATE ISSUED
43.7:0'g *.28.00g1-
PERMIT NO. TOTAL