1980, 03-28 Permit: G-80-2818 Mechanical Fixtures1-'LAN 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 4 COPIES
1.
2.
3.
JOB ADDRESS
E--/e‘
LEGAL DESCRIPTION - SEE ATTACHED
LOT
BLOCK
SUBDIVISION
PARCEL NUMBER /S
OWNER 9.
ADDRES
PHONE
ZIP
Required Set Backs in Feet
North (South East 'West
4.
CONTRACTOR
ADDRESS
c2 i.�,ti.z
j9= o (i-1-9( 73
DESIGNER
5. ADDRESS
PHONE
9f9.X733
Size of Parcel
Zone Classification
ZIP
7J 7
PHONE
Type Const.
Occupancy Sprinklered
❑Yes ❑No ❑ Req'd.
Valuation Building Area in Sq. Ft.
ZIP
DWL Area I Basement Area Garage Area
Storage
CHANGE OF USE FROM
6.
TYPE
7. OF
WORK
TO
Split Entry
Split Level
Rancher
,NEW ❑ ALT. ❑ AD'N. ❑ RPL. ❑ MVE.
❑ BLD. ❑ PLMB. A MECH: ❑ M.H. ❑ POOL
❑ OTHER
No. Baths
No. Floors
No. Rooms
Rec. Room
CERTIFICATE
of EXEMPTION
Req'd.
Rec'd.
Not Req'd.
DESCRIBE WORK
8. 442,__.
VALUATI
9.
/00 M
Source
of
Utilities
GAS
ELECTRIC
WATER
SEWER
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 co nstruction.
DATE y/i 7 L % k) SIGNATURE _
SPECIAL APPROVALS
DEPT. REQ'D. REC'D.
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Zone Clearance
SEPA Checklist
SPECIAL CONDITIONS:
ft
/ Z_
3a pt--
DATES •Q$ C6D OFFICIAL
APPROVED FOR ISSUANCE
FEES COLLECTED
Single $
Building
Plumbing
u�r
Mech. 1 �
Plan Check
SEPA
Mobile Home
Other (Specify)
r/ TOTAL $ %�� —t
PERMIT NUMBER
1q
DATE 3! 7! ea
04* *1200
*1200 to-
*12006
E *000
281.7s
03 -28 -80
g 6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
'03- 28 -'80
28185 *12.00(03.1:1.
RECORD OF INSPECTIONS
REMARKS
*j'
Final Inspection
INSPECTED BY
4.1 00
I', Cl * * 1 5 0 0