1982, 06-29 Permit: 82A-5539 Plumbing Fixtures[.LAN NUMBER
ft)
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
2.
BLOCK
SUBf V4S Oz WAI . TJ —,
LEGAL DESCRIPTION — SEE ATTACHED
PARCEL NUMBER/S
OWNER` 7.
�67 _ i
ADDRESS 62j
i
CONT CTOR/ ) (•_'5 r-' 0_,7 a
0.. Ai -t: ..,
4.
A D Dyt E 55,4,
DESIGNER
5.
PHONE
.sem 3-•_
ZIP
PH9NE
Actual Set Backs in Feet
North 'South
East 'West
Size of Parcel Zone Classification
ZIP
Type Const.
Occupancy Sprinklered
❑Yes ❑No ❑ Req'd.
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
8.
9.
a NEW
❑ BLD.
DESCRIBE WORK
VALUATION
❑ ALT.
PLMB.
❑ AD'N.
❑ MECH.
❑ RPL.
❑ M.H.
❑ MVE.
❑ POOL
❑ OTHER
No. Baths
No. Stories
No. Rooms
No. of Dwellings
CERTIFICATE
of EXEMPTION
Req'd.
Rec'd.
Not Req'd.
SOURCE
OF
UTILITIES
`/1/
GAS I ELECTRIC
WATER
SEWER
Enum. Dist.
Ownership
Public ❑ Private ❑
Location (Area)
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 regul.ng construction or the
performance of construction. SEE REVERSE SIDE FOR REQUIRED INSPECTIO
DATE OF APPLICATION
SIGNATURE OF APPLICANT
SPLZCIAL APPROVALS
NAME DATE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
SPECIAL CONDITIONS:
1—P514 --ave r
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 $ /16Y`
PERMIT NUMBER
I36 7
03* * 1 81,00
*181.006
A *0.00
55382
06-29-82
g_ 6.479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
06'•'2'9-8`2 553.92 *181,0021-:'
DATE ISSUED
PERMIT NO. TOTAL