1980, 06-02 Permit: 80-5187 Gas Piping_' AN MBER /�
•0 On
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
1.
2.
JOB ADDRESS
)1 3 6 a a�?��,t,rYLJ
LOT LOCK SUBDIVISIO
LEGAL DESCRIPTION - SEE ATTACHED
PARCEL NUMBER/S
OWNER
3. �iLt�r.'�ri-�"'f�t�
ADDRESS
SLYr✓'��
PHONE
ZIP
Required Set Backs in Feet
North 'South East 'West
CONTRACTOR /`f
4. ADDRESS (/ [�YtI CO
A
DESIGNER
5' ADDRESS
•
PHONE
Size of Parcel Zone Classification
ZIP
Type Const.
Occupancy Sprinklered
❑Yes ❑No 0 Req'd.
PHONE
Valuation I Building Area In Sq. Ft.
ZIP
DWL Area
Basement Area 11 Garage Area
Storage
CHANGE OF USE FROM
6.
TO
Split Entry
Split Level
Rancher
TYPE
7. OF
WORK
❑ NEW
❑ BLD.
❑ ALT. 0 AD N. 0 RPL. 0 MVE.
❑ PLMB.Sy/MECH. 0 M.H. 0 POOL
0 OTHER
No. Baths
No. Floors
No. Rooms
Rec. Room
CERTIFICATE
of EXEMPTION
Req'd.
Recd.
Not Req'd.
DESCRIBE WORK
8.
VALUATION
9.
Source
of
Utilities
GAS
ELECTRIC
WATER
SEWER
I hereby certify that I have read and examined this applica ion 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
SIGNATURE
DEPT.
SPECIAL APPROVALS
REQ'D. REC'D.
Env. Health
Planning
Fire Marshall •
Co. Engineer
Utilities
Zone Clearance
SEPA Checklist
SPECIAL CONDITIONS:
FOR GAS: /p
PIPE SIZES:
PIPE LENGTHS:
BTU'S:
DATE ( 5C OFFICIAL 1 ±TiACJYVY‘)
APPROVED FOR ISSUANCE
FEES COLLECTED
Single $
Building
•
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
•
00
TOTAL $ Q
PERMIT NUMBER
DATE
04* - *9.00
*9.00
*9.006
B *000 8
518.6B
06.02-80
2 6479,
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
b6LD'2 80 518,71 u'9.00,2.'pe
•