1980, 09-04 Permit: 80-9630 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
1.
2.
3.
JOB ADDRESS
LOT BLOCK SIfBDIV SION
LEGAL DESCRIPTION - SEE ATTACHED
OWN
ADDRESS
PHONE
ZI P
PARCEL NUMBER/S
Actual Set Backs in Feet
North !South East (West
CONTR CTO
4' DDRESS
/3_; L
DESIGNER
PHONE
Size of Parcel Zone Classification
5. ADDRESS
ZIP
99 i ''
PHONE
Type Const.
Occupancy Sprinklered
❑Yes ❑No ❑ Req'd.
Valuation
Building Area in Sq. Ft.
ZIP
Main Floor Upper Floors
Garage Area
Storage
CHANGE OF USE FROM
6.
TYPE
7. OF
WORK
TO
Area of Decks
Finished Basement
Unfin. Basement
Q,WEW ❑ ALT. ❑ AD'N. ❑ RPL. ❑ MVE.
❑ BLD. CPLMB. ❑ MECH. ❑ M.H. ❑ POOL
❑ OTHER
No. Baths
No. Stories
No. Rooms
No. of Dwellings
CERTIFICATE
of EXEMPTION
Req'd.
Rec'd.
Not Req'd.
DESCRIBE WORK
8.
VALUATION
9.
SOURCE
OF
UTILITIES
T;!
GASi EL ECTRIC
Enum. Dist.
ILocation (Area)
WATER
SEWER
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 INSPECTIONS
9%/ SIGNATURE OF APPLICAN % ..4;6/
SPECIAL CONDITIONS:
DATE OF APPLICATION
SPECIAL APPROVALS
NAME DATE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
PERMIT IS NONTRANSFERABLE
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL $
PER+VIIT NUMBER
Lgo -e9
)3*
* 2800
* 2800
* 28.006
E *0.00 8
96292
09-04-80
Q 6479,
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
'09+0 4`'rBIO 9'6.3.05. *28.0021-2
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE DATE ISSUED PERMIT NO. TOTAL