1980, 12-09 Permit: 80B-4612 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
JOB ADDRESS
LOT
2.
BLOCK
06 (I -6A ditet,
SUBDIVISION
3.
OWNER
PHONE
LEGAL DESCRIPTION - SEE ATTACHED
PARCEL NUMBER/S
ADDRESS
%i. 361a N2...0 ,..t
ZIP
cige
CONTR TOR
4. i ti, D ►�S-t� .
A7ESS
PHONE
9',X+:77//.3
ZIP
0027
5. `V'1
ADDR
6.
PHONE
f)x /409i/
CHANGE OF USFROM
TYPE
7. OF
WORK
9.
—NEW
❑ BLD.
DESCRIBE WORK
VALUATION
ZIP
TO
❑ ALT. ❑ AD'N.
PLPLMB. ❑ MECH.
SOURCE
OF
UTILITIES
❑ RPL.
❑ M.H.
GAS
ELECTRIC
❑ MVE.
111 POOL
WATER
❑ OTHER
SEWER
Actual Set Backs in Feet
North South East (West
Size of Parcel
Type Const.
Occupancy
Valuation
Main Floor
Upper Floors
Area of Decks
No. Baths
Zone Classification
Sprinklered
❑Yes ❑No ❑ Req'd.
Building Area in Sq. Ft.
Garage Area
Finished Basement
Storage
Unfin. Basement
No. Stories
CERTIFICATE
of EXEMPTION
No. Rooms
No. of Dwellings
Enum. Dist. 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 la/ w ,• s 1• g con ruction or the
performance of construction. SEE REVERSE SIDE FOR REQUIRED INSPECTIO
DATE OF APPLIC '"ION � A:20 SIGNATURE OF APPLICANT
�� /
-'
SPECIAL APPROVALS
NAME DATE
Env. Health
Planning
Fire Marshall
Co. Enginee
Utilities
Plans Examiner
SEPA Checklist
SPECIAL CONDITIONS:
abs
/ Skewer"
"
I 12,64.1.00_,4e1-
r
! ja/
dd I' / /ez-hr
/ i,c,a116 rie,/
l 1=Ic)a r4;
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)
$
_J2±0
TOTAL
r RMIT NUMBER
03* *5000
*5000 3
*50,006
A *000
461,18
12-09-80
6479.
!MEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
12;-(0-10‘ 46i2g° *50.0021:1 -
DATE ISSUED
PERMIT NO. TOTAL