1980, 12-16 Permit: 80B-4882 Mechanical Fixtures(PLAN 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.
4.
JOB ADDRESS
LOT BLOCK
OWNE
ADDRES
SUc (�
B! (VISION
C a,.�
LEGAL DESCRIPTION — SEE ATTACHED
CONTRACTOR
ADDRESS
DESIGNER
ADDRESS
CHANGE OF USE FROM
6.
TYPE
7, OF
WORK
9.
PHONE
ZI P
PHONE
C-2,4
ZI P
PHONE
ZIP
TO
!NEW ❑ ALT. ❑ AD'N. ❑ RPL. ❑ MVE.
❑ BLD. ❑ PLMB. ,MECH. ❑ M.H. ❑ POOL
DESCRIBE WORK
VALUATION
tirv—
SOURCE
OF
UTILITIES
GAS
ELECTRIC
XX
WATER
❑ OTHER
SEWER
PARCEL NUMBER/S
Actual Set Backs in Feet
!South (East
North
Size of Parcel
West
Zone Classification
Type Const.
Occupancy
Valuation
Main Floor
Sprinklered
Eyes ❑No ❑ Req'd.
Building Area in Sq. Ft.
Upper Floors Garage Area
Area of Decks Finished Basement
No. Stories No. Rooms
No. Baths
Storage
Unfin. Basement
No. of Dwellings
CERTIFICATE
of EXEMPTION
Enum. Dist. I Location (Area)
Ownership
Public ❑ Private ❑
Req'd.
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
DATE OF APPL CATION
SPECIAL APPROVALS
NAME DATE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
SIGNATURE OF APPLICANT
SPECIAL CONDITIONS:
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
Rec'd.
Not Req'd.
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL
V n
0QJ
IPE,RMIT NUMBER
til icy 2--
04* *9.00
*9,00 N
*9.006
A *0,00
488.1 g
12-16-80
g 6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
12 yl t.
DATE ISSUED �' '`" PERMIT NO.
488,22
*9.00 I-