1980, 02-21 Permit: 80-1381 Plumbing Fixtures1
If'LAN NUMBER
1
APPLICATION/PERMIT
SPOKANE COUNTY - BUILDING CODES DEPARTMENT
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
JOB ADDRESS
LOT
2.
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 4 COPIES
BLOCK5zSBD'VISION �� S
LEGAL DESCRIPTION — SEE ATTACHED
PARCEL NUMBER/S
3.
4.
OWNER
ADDRESS
PHONE
CONTRA TOR
AD RESS
f�'R /q7///
5.
ADDRESE
ZIP
r �t771h
sc- (7t6 7
PHONE
z"7.,7/5/
,7,/
Required Set Backs in Feet
North JSouth
Size of Parcel
Type Const.
East (West
Occupancy
Zone Classification
O. Dx / 7'
CHANGE OF USE FROM
6.
PH9NE
X35=Sfi
ZIP
Valuation
Sprinklered
❑Yes ❑No ❑ Req'd.
Building Area in Sq. Ft.
TO
DWL Area I Basement Area
Garage Area Storage
Split Entry
Split Level
Rancher
7.
8.
9.
TYPE
OF
WORK
VEW
❑ BLD.
DESCRIBE WORK
VALUATION
0 ALT. 0 AD'N.
j:KPLMB. ❑ MECH:
❑ RPL. ❑ MVE.
0 M.H. ❑POOL ❑OTHER
/3 / X -tic ri14)
Source
of
Utilities
GAS
No. Baths
No. Floors
No. Rooms
Rec. Room
CERTIFICATE
of EXEMPTION
Req'd.
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
performanceof const ction.
IX() DATE const
examined this application and have read
to be true and correct. All provision
whether specified herein or not. Th
the provisions of any other state o
SPECIAL APPROVALS
DEPT. REQ'D.
REC'D.
SIGNATURE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Zone Clearance
SEPA Checklist
SPECIAL
"NOTICE" provisions included
and ordinances governing this
of a .•rmit do not presume
co njjt uction or the
ON 1 ITIONS:
•
DATE Pft-at`C1L]OFFICIAL �tl. y\:,
APPROVED FOR ISSUANCE
Recd.
Not Req'd.
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL
PERMIT NUMBER
it -p 9)o—i3cb1
DATE
03* *3550
*35.50
*35506
E *000 0
13808
02-21-80
g 6,479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THItB7c MFr$A(�RMIT.
138.12 *35.500)
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w
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