1980, 12-04 Permit: 80B-4476 Mechanical Fixtures❑ ALT. ❑ AD'N. ❑ RPL. ❑ MVE.
❑ PLMB. 21,MECH. ❑ M.H. ❑ POOL
(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
LOT
BLOCK
3.
OWNER
ADDRESS
SUBDIVISION
937e.:' / /""E'lfy
4' ADDRESS
/Y, i`i y fir
CONTRACTOR
DESIGNER
PHONE
ro 5r
ZIP
ADDRESS
CHANGE OF USE FROM
6.
7.
TYPE
OF
WORK
.6Y'NEW
❑ BLD.
ZIP
PHONE
ZIP
TO
DESCRIBE W RK/
8. v. l,� /,',.!
SOURCE
OF
UTILITIES
VALUATION
9.
❑ OTHER
GAS ELECTRIC
WATER
LEGAL DESCRIPTION - SEE ATTACHED
PARCEL NUMBER /S
Actual Set Backs in Feet
North South
Size of Parcel
Type Const.
Occupancy
Valuation
Area of Decks
No. Baths
East (West
Zone Classification
Sprinklered
❑Yes ❑No ❑ Req'd.
Building Area in Sq. Ft.
Garage Area
Finished Basement
No. Stories
CERTIFICATE
of EXEMPTION
Enum. Dist.
SEWER
Storage
Unfin. Basement
No. Rooms
No. of Dwellings
Req'd.
Location (Area)
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/0C--<- rSIGNATURE OF APPLICAN
SPECIAL APPROVALS
NAME DATE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
Building Technician
9 S. 6,
SPECIAL CONDITIONS:
/d d�� , s' `u c e
/ ev1/,7, /aal4,'
l tNCi
0
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
Rec'd. Not Req'd.
FEES COLLECTED
Single $ `5
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL
PERMIT NUMBER
80B-4477
04* *15.00
* 1500 N
* 1 5008
A *0..00 8
447.52
12 -04 -80
z 6479.
4 +47,6'2
Lqn
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
12704' 8
DATE ISSUED
*15.,0i0.?. � -
PERMIT NO. TOTAL