1981, 04-09 Permit: 81A-3336 Water Softeneriize of Parcel
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 COPIEf-
JOB ADDRESS
5. ((c -fir
LOT
BLOCK
3.
SUBDIVISION
OWNER Iv,V J Ili
A REST( 4-(-D�
PHONE
-ala
LEGAL DESCRIPTION — SEE ATTACHED
PARCEL NUMBER/S
4.
CONTRACTOR
ZIP
3�?
PHONE
ADDRESS
DESIGNER
5. ADDRESS
CHANGE OF USE FROM
6.
TYPE
7. OF
WORK
ZIP
PHONE
ZIP
TO
NEW ❑ ALT. ❑ AD'N. ❑ RPL. ❑ MVE.
,�,� ❑ OTHER
❑ BLD. lLf'PLMB. 0 MECH. ❑ M.H. ❑ POOL
SOURCE
OF
UTILITI ES
GAS
ELECTRIC
WATER
SEWER
Actual Set Backs in Fee
(South
North
'East West
Type Const.
Occupancy
Valuation
Main Floor
Upper Floors
Area of Decks
No. Baths
Zone Classification
Sprinklered
Dyes ❑No ❑ Req'd.
Building Area in Sq. Ft.
Garage Area
Finished Basement
No. Stories
CERTIFICATE
of EXEMPTION
Enum. Dist.
Storage
Unfin. Basement
No. Rooms
No. of Dwellings
Req'd. Rec'd.
Location (Area)
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
DATE OF APP! 'ATION__
SIGNATURE OF APPLICANT
SPECIAL APPROVALS SPECIAL CONDITIONS:
NAME DATE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
Not Req'd.
FEES COLLECTED
Single $
Building
cc)
Plumbing 7'
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
Ca, c2c7
TOTAL $
PERMIT NUMBER
*5.00
*500 0)
*5,000
A *0,00
333.52
04-09-81
R. 6,479,
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
1,7 D: '1$'1` 3 3 3i6'z *5. 0 0 a pi -
DATE ISSUED PERMIT NO. TOTAL