1980, 02-27 Permit: 80-1570 Plumbing FixturesPLAN N -UMBER
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 4 COPIES
1.
2.
3.
4.
JOB ADDRESS
L T BLOCK
IUBDIVIS
LEGAL DESCRIPTION — SEE ATTACHED
PARCEL NUMBER/S
5.
OyfNE�
ADDRESS
1, /. // J3za'ac�424-1244e_t-
CONTRACTOR wwAA'',,
PHONE
zlo-9oz
ZIP
94.2-d�
PHONE
Required Set Backs in Feet
North 'South [East 'West
Size of Parcel 1 Zone Classification
ADV ESS
DESIGNER
ZIP
Type Const.
Occupancy
Sprinklered
❑Yes ❑No El Req'd.
PHONE
Valuation (Building Area in Sq. Ft.
ADDRESS
ZIP
DWL Area l Basement Area r Garage Area
Storage
CHANGE OF USE FROM
6.
TYPE
7. OF
WORK
TO
Split Entry
Split Level
Rancher
❑ NEW
❑ BLD.
❑ ALT.
A PLMB.
D AD'N.
O MECH.
O RPL.
O M.H.
❑ MVE.
O POOL
0 OTHER
No. Baths
No. Floors
No. Rooms
Rec. Room
CERTIFICATE
of EXEMPTION
Req'd.
Recd.
Not Req'd.
DE/�S.CRIBE WORK ��
8 VALUATION
9.
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 .sting of a permit does not presume
to give authority to violate or cancel the provisions of any other state • loc.I law regulating constructi•. or he
performance�jof construction.
DATE 2. -.Z7 -8a SIGNATURE
DEPT.
SPECIAL APPROVALS
REQ'D. REC'D.
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Zone Clearance
SEPA Checklist
IC:ME OWNER'S WA RANTY
__ YES L
No
FEES COLLECTED
Single S
Building
"///plumbing
ch
Plan Check
SEPA
Mobile Home
Other (Specify)
SPECIAL CONDITIONS:
a2-27—?D
DATE OFFICIAIOCt;(.44W1-/
APPROVED FOR ISSUANCE
TOTAL $
PERMIT NUMBER
?4'""' 7D
DATE -2- —
03* *15.50
* 1550
* 15506
B *000 8
1569B
02-27-80
B 6479,
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
02L'2'T='8 '0' 157.02 *1550a