1981, 07-06 Permit: 81A-6672 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
cJ
LOT BL CK SUBDIVI ION
3 OWNER -y"R; rr 141)1111\i0
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7
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4.
ADDRESS
DESIGNER
PHONE
ZI P
PHONE
LEGAL DESCRIPTION - SEE ATTACHED
PARCEL NUMBER/S
7
PHONE
ADDRESS
ZIP
CHANGE OF USE FROM
6.
TYPE
7. OF
WORK
TO
4:4ZW ❑ A.T. ❑ AD'N. ❑ RPL. ❑ MVE.
❑ BLD. LJ PLMB. ❑ MECH. ❑ M.H. ❑ POOL
Actual Set Backs in Feet
North South
Size of Parcel
Type Const.
Occupancy
East
West
Zone Classification
Sprinklered
❑Yes ❑No D Req'd.
Valuation Building Area in Sq. Ft.
Main Floor
Upper Floors Garage Area 1 Storage
Area of Decks
0 OTHER
No. Baths
Finished Basement Unfin. Basement
No. Stories
No. Rooms
No. of Dwellings
CERTIFICATE
of EXEMPTION
Req'd.
9.
DESCRIBE ORt$1 k�LJ
VALI TION SOURCE AS ELECTRIC
OF
UTILITIES
WATER
Enum. Dist.
Location (Area)
SEWER
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 APPLICATION 7'_ Z ` SIGNATURE OF APPLICANT ..1
SPECIAL APPROVALS
NAME DATE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
SPECIAL CONDITIONS:
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
Rec'd. Not Req'd.
FEES COLLECTED
Single $
Building
Plumbing
e/
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL
p
PERMIT NUMBER
03* *69.00
*69.00
*69.008
A *0.00
667.1R
0Q-06-81
2 6479,
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
'oft -lot -,841
DATE ISSUED
667,2z
PERMIT NO.
*69.00 ��