1981, 11-16 Permit: 81B-1829 Mechanical FixturesPLAN NUMBER
APPLICATION/PERMIT
SPOKANE COUNTY — BUILDING CODES DEPARTMENT
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
JOB ADDRESS
1. / 4103 4 c keel -c-
LoT BLOCK #JBDIVISIOA
APPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 3 COPIES
LEGAL DESCRIPTION - SEE ATTACHED
2.
OWNER
3.
ADDRESS
CONTRACTOR em,
//4, 3 ifirek7
Atfr/ Hr
4. ADDRESS
Ar, 417/v /A,"
DESIGNER
PHONE
9AA - 4/6P 5—
ZIP
519;Ze
r IA- c
PHONE
C'etv
PARCEL NUMBER/S
Actual Set Backs in Feet
North South 1ast 'West
Zone Classification
Size of Parcel
ZIP
99.4 /6
PHONE
Type Const. OccupancY Sprinklered
0Yes 0No Req'd.
1
Valuation Building Area in Sq. Ft.
5.
ADDRESS
ZIP
6.
CHANGE OF USE FROM tTO
TYPE
7, OF
WORK
El NEW
E3 BLD.
O ALT.
O PLMB.
o
AD'N.
0 MECH.
O RPL.
O M.H.
o MVE.
O POOL
0 OTHER
1IMain Floor Upper Floors Garage Area Storage
Area of Decks 1 Finished Basement I
No. Baths No. Stories
Unfin. Basement
No. Rooms I No. of Dwellings
CERTIFICATE
of EXEMPTION
Location (Area)
Enum. Dist.
Req'd.
Recd. Not Req'd.
DESCRIBE WORK
8. klis" ta // Op-Ave,t i .- icpt-Aew c e c i 1 , Aeic HTR PA,
OF 1 ELECTRIC WATER 1 SEWER
VALUATION SOURCt GAS
9. UTILITIES
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 laweregulating construction or the
performance of construction. SEE REVERSE SIDE FOR REQUIRED INSPECTIONS
DATE OF APPLICATION .2 - 4?- SIGNATURE OF APPLICANT27
SPECIAL APPROVALS
NAME DATE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
tos.Q1 -Techni ia
SPECIAL CONDITIONS:
,1,7 e A:- 71e A -^1 .07, (1 • k
F, 170c -A-/ IP -Ai-
Ownership I USE CODE
Public 0 Private 0
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
FEES COLLECTED
Single
Building
Plumbing
Mech.
0" 0./15
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL $
PERMIT INIAJMBERx
21
g
0 * 1 9, 0 0
* 1 9.0 0
A * 0, 0 0
1 8 2.8
1 1 - 1 6 8 1
61179,
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATE ISSUED
1 8 2, 9 * 1 9. 0 0 2. -
PERMIT NO. TOTAL