1980, 01-13 Permit: 81A-0402 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
JOB ADDRESS
LOT
4C-7/ mac) ,j 7
BLOCK SUBDIVISION
LEGAL DESCRIPTION - SEE ATTACHED
OWNER
3.
ADDRESS
CONT
4. AD,gRESS
N• 4,'CX 7 ifV\
DESIGNER
ADDRESS
CHANGE OF USE FROM
6.
TYPE
7. OF
WORK
PHONE
ZI P
PHONE
ZIP
g,
PH6NE
ZIP
TO
NEW 0,ALT. 0 AD'N. 0 RPL. ❑ MVE.
1=14d
BLD. 'PLMB. 0 MECH. 0 M.H. 0 POOL
❑ OTHER
DESCRIBE WORK
)
VALUATION
9.
SOURCE
OF
UTILITIES
GAS
ELECTRIC
WATER
SEWER
PARCEL NUMBER/S
Actual Set Backs in Feet
1South East
North
Size of Parcel
Type Const.
Occupancy
West
Zone Classification
Sprinklered
❑Yes ❑No ❑ Req'd.
Valuation
Main Floor
Upper Floors
Area of Decks
No. Baths
Building Area in Sq. Ft.
Garage Area
Finished Basement
No. Stories
CERTIFICATE
of EXEMPTION
Enum. Dist.
Storage
Unfin. Basement
No. Rooms
Req'd.
No. of Dwellings
Rec'd.
Not Req'd.
Location (Area)
Ownership
Public 0 Private 0
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 INSPECIONS
DATE OF APPLICATION /-1"2)' SIGNATURE OF APPLICA
SPECIAL APPROVALS
NAME DATE
Env. Health
Planning
Fire Marshall
Co. Enginee
Utilities
Plans Examine
SEPA Checklist
ing Technic
SPECIAL CONDITIONS:
PERMIT IS NONTRANSFERABLE
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL $
PERMIT NUMBER
03*
*21.00
*21.00 N
401g
01-13-8p
6479,
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
j ]
0la'+ifl'�-113
40.2 *2100a� -
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE DATE ISSUED PERMIT NO. TOTAL