1981, 05-15 Permit: 81A-4752 Plumbing Fixtures[LAN 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 4 COPIES
1.
2.
3
JOB ADDRESS
LOT
E. ttBit)5" cAc_ ti
BLOCK
SUBDIVISION
LEGAL DESCRIPTION — SEE ATTACHED
PARCEL NUMBER/S
OWNER
M dkv
ADDRESS
4.
W. 'J C i t)
tau2$
GRrk
PHONE
45-(6-'-8v i
CONTRACTOR nt
�ZCX,O 1tt
(�_ c"1tC�kt
ADDRESS
Required Set Backs in Feet
North !South
East
West
PHONE
et Z4 -3t a?
Size of Parcel
Zone Classification
ZIP
Type Const.
Occupancy
Sprinklered
❑Yes :No D Req'd.
DESIGNER
5. ADDRESS
PHONE
Valuation
Building Area in Sq. Ft.
ZIP
DWL Area I Basement Area
Garage Area
Storage
CHANGE OF USE FROM
6.
TO
Split Entry
Split Level
Rancher
TYPE
7. OF
WORK
VNEW ,❑ALT. _,/
❑ BLD. LAG PLMB.
❑ AD'N.
❑ MECH:
❑ RPL.
❑ M.H.
❑ MVE.
❑ POOL
❑ OTHER
No. Baths
No. Floors
No. Rooms
Rec. Room
CERTIFICATE
of EXEMPTION
Req'd.
Rec'd.
Not Req'd.
DESCRIBE WORK
8. a Ft
VALUATION
9.
Source
of
Utilities
GAS
ELECTRIC
WATER
SEWER
I hereby certify that I have read and
on reverse side, and know the same
type of work will be complied with
to give authority to violate or cancel
performance off onstyuction.
(' 7
DATE ' / /
examined this application and have read
to be true and correct. All provisions of
whether specified herein or not. The gra
the provisions of any other state or lo
SIGNATURE
the "NOTICE" provisions included
la sgi ordinances governing this
ing of a' ermit does not presume
law regula ing construction or the
SPECIAL APPROVALS
DEPT. REQ'D.
REC'D.
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Zone Clearance
SEPA Checklist
HOME OWNER'S WARRANTY
YES IJ
No ' l
SPECIAL CONDITIONS:
SNt'c��R_
icit�;cS
A SrNw=
AYs•++D .pt P :
DATE 5//q, / OFFICIAL�rL//
APPROVED FOR ISSUANCE
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
4t 0
TOTAL $ 4bal
PERMIT NUMBER
-4152-
DATE S//SlJ 1
* 41,00
* 41.00
* 41.00
A *0,00 8
4751
05-15-81
6479,
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS CO to MIT.
( ..47522
*1410Oa,-