1980, 12-04 Permit: 80B-4474 Plumbing FixturesPLAN 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
2.
3.
JOB ADDRESS
LOT SUBDIVISION
BLOCK
LEGAL DESCRIPTION - SEE ATTACHED
OWNER
/ a/
ADDRESS
SG3
CON RACTO
e
4' ADDR€SS
5 7:1/t-/
PHONE
ZIP
PARCEL NUMBER /S
Actual Set Backs in Feet
North 1South
East
(West
PHONE
ZIP
'�C3 �9
Size of Parcel
Zone Classification
Type Const.
Occupancy
Sprinklered
❑Yes ❑No ❑ Req'd.
5.
DESIGNER
PHONE
Valuation
Building Area in Sq. Ft.
ADDRESS
ZIP
Main Floor
Upper Floors
Garage Area
Storage
CHANGE OF USE FROM
6.
TO
Area of Decks
Finished Basement
Unfin. Basement
TYPE
7. OF
WORK
XNEW
❑ BLD.
❑ ALT. ❑ AD N. ❑ RPL.
❑ PLMB. DkMECH. ❑ M.H.
❑ MVE.
❑ POOL
❑ OTHER
j >r
No. Baths
No. Stories
CERTIFICATE
of EXEMPTION
No. Rooms
No. of Dwellings
Req'd.
Rec'd.
Not Req'd.
9.
DESCRIBE WOR
l
VALUATION
SOLtE
OF
UTILITIES
74; z'4:c/Ake' 114/1
GAS
ELECTRIC
WATER
SEWER
Enum. Dist.
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 /2 2'—G e' SIGNATURE OF APPLICANT
SPECIAL APPROVALS SPECIAL CONDITIONS:
NAME DATE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
Building Technician
1.ba l ono - BrL
-Pc pc a^) r1
A
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 $
PERMIT NUMBER
&3 - +f74
04* *1500
*1500 N
* 1 5.006
A *000 8
447,32
12 -04 -80
z 6479,
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
121.714'-8
DATE ISSUED
4''4' 4'g
PERMIT NO.
1501paP —
TOTAL