1981, 09-28 Permit: 81A-9905 Mechanical 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
3.
JOB ADDRESS
LOT BLOCK
OWNER
563
SUBDIVISION
-e-I6 AlS
ADDRESS n'y SO u R/JS
4.
CONTRACTOR
r c%'lit//L 'U 23( !fr C ('
ADDRESS
44,�
DESIGNER
5. ADDRESS
CHANGE OF USE FROM
6.
TYPE
7, OF
WORK
ZIP
ZIP9 9 G t
PHONE
ZI P
TO
❑ NEW LALT. ❑ AD'N. ❑ RPL. ❑ MVE.
❑ BLD. ❑ PLMB. ❑ MECH. ❑ M.H. ❑ POOL
❑ OTHER
qESCRIBE WORK
C -n "f aee /6 el P26 r' KB E
VALUATION
9.
SOURCE
OF
UTILITIES
GA�
uCi ✓,
ELECTRIC
WA
Ras,r),pirvel
S WER'
LEGAL DESCRIPTION — SEE ATTACHED
PARCEL NUMBER/S
Actual Set Backs in Feet
North South
Size of Parcel
Type Const.
Occupancy
Zone Classification
Sprinklered
(=Yes ❑No ❑ Req'd.
Valuation
Main Floor
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
Location (Area)
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 INSPECTION
DATE OF APPLICA'';�SN
SIGNATURE OF APPLICANT
SPECIAL APPROVALS
NAME DATE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
• Building Technician
SPECIAL CONDITIONS:
/O00CJ .gry C7k5 kotf
(ef
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
No. of Dwellings
FEES COLLECTED
Single $
Building
Plumbing
tJG
Mech. r4
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL
CO oA
$
PERMIT NUMBER
SIA— 9q�5
04*
* 1600 chtCic
* 1600
990.42
09-28-81
z 6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
0191-1i2' a- ell 9 9 Q 5 Z * 1:6.0 0 0 j
DATE ISSUED PERMIT NO. TOTAL