1980, 06-04 Permit: 80-5334 Plumbing FixturesNUMBER
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
JOB ADDRESS
LOT
BLOCK
SUBDIVISION
3
OWNER
ADDR ESS
•
PHONE
LEGAL DESCRIPTION - SEE ATTACHED
PARCEL NUMBER/S
ZIP
Required Set Backs in Feet
'South
North
[East 'West
CONTRACTOR
4.
ADDRESS�''�</
DESIGNER
ADDRESS
CHANGE OF USE FROM
6.
TYPE
7. OF
WORK
PHONE
f -3/2/
ZIP ^�'�
C %O�
Size of Parcel
PHONE
ZIP
TO
�JVEW .❑.,(ALT. ❑ AD'N. ❑ RPL. ❑ MVE.
gBLD. LXl PLMB. ❑ MECH: 0 M.H. ❑ POOL
Type Const. Occupancy
Zone Classification
Sprinklered
❑Yes ❑No ❑ Req'd.
Valuation
DWL Area
No. Baths
Building Area in Sq. Ft.
Garage Area
Split Level
CERTIFICATE
of EXEMPTION
Storage
Rancher
No. Rooms
Req'd.
Rec. Room
Rec'd.
Not
Req'd.
DESCRIBE WORK
/1/21-3 /.t) ✓ /Lt✓'t //I/e /.3k/
VALUATION
9.
1j f'5 �,IP
tc<I [
Source I GAS ELECT'RJC
of
Utilities
WATR.
SEWER
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.
DATE
DATE°' l n SIGNATURE
DEPT.
SPECIAL APPROVALS
REQ'D. REC'D.
Env. Health
Plann ing
Fire Marshall
Co. Engineer
Util ities
Zone Clearance
SEPA Checklist
SPECIAL CONDITIONS:
DATE
OFFICIAL 40 -41414.44 -
FEES COLLECTED
PERMIT NUMBER
DATE 6
03* *3800
*3800
*38006
E *000
533.38
06-04-80
6479.
Single $
Building
" i'/ � % �'$
Plumbing ,50
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
$ 3T ,
TOTAL
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
00404f-805133,45 *38.002.17-1
APPROVED FOR ISSUANCE -