1980, 12-02 Permit: 80B-4366 Plumbing FixturesPLAN NUMP =R
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
/0 /'/
LOT
LOCK
2.
SUBDNISIO
3. oW <c�L ��d2fl
ADDRESS
PHONE
LEGAL DESCRIPTION - SEE ATTACHED
PARCEL NUMBER /S
CONT TORj�r
4. G�i b
D
DESIGNER
5' ADDRESS
ZIP
Actual Set Backs in Feet
North 'South East (West
PHONE
ZIP
yy /
PHONE
Size of Parcel
Zone Classification
Type Const.
Occupancy
Sprinklered
❑Yes ❑No ❑ Req'd.
Valuation I Building Area in Sq. Ft.
ZIP
Main Floor
Upper Floors I Garage Area
Storage
CHANGE OF USE FROM
6.
TYPE
7. OF
WORK
TO
Area of Decks
Finished Basement
Unfin. Basement
0.-A4£W ❑ ALT. ❑ AD N. ❑ RPL. ❑ MVE.
❑ BLD. Q-'PLMB. ❑ MECH. ❑ M.H. ❑ POOL
❑ OTHER
No. Baths
No. Stories
No. Rooms
No. of Dwellings
CERTIFICATE
of EXEMPTION
Req'd.
Rec'd.
Not Req'd.
DESCRIBE WORK
8.
VALUATION
9.
SOURCE
OF
UTILITIES
ELECTRIC
WATER
Enum. Dist. I Location (Area)
SEWER
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
SIGNATURE OF APPLICANT
SPECIAL APPROVALS I SPECIAL CONDITIONS:
NAME DATE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
Buildin Tec nicia z t
c:4-)//
PERMIT IS NONTRANSFERABLE
FEES COLLECTED
Single $
Building
Plumbing Zrn,
. % Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL $
T
PERMIT NUMBER
8/113- -y3do l -
03* *28.00
*2800
*28.006
A *000 8
436.52
1202 -80
6479
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
12,-.0,2- 718 O
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE DATE ISSUED
43.6 *,24O,010
PERMIT NO. TOTAL