1981, 04-03 Permit: 81A-3058 Mechanical FixturesAPPLICATIO /PERMIT
SPOKANE COUNTY—13U[31NG CODES DEPARTMENT
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 3 COPIES
1 IIJJ JO DDRE6b((// LEGAL DESCRIPTION -SEE ATTACHED
LOT B=W-71VISION PARCEL NUMBER/S
2.
3.
ADDRESS
ZIP
Actual Set Backs in Feet
�O
'e
z �
North South East
West
ONTR Tj,OR/
l CVG .1
PnINE
b IP6 -406s-
4 s^4.
Size of Parcel
Zone Classification
4.
ADDRSSe_jZI
Type Const.
Occupancy
Sprinklered
❑Yes [-]No ❑ Req'd.
DESIGNER
PHONE
Valuation
Building Area in Sq. Ft.
5.
ADDRESSV�
ZIP
Main Floor
I Upper Floors
Garage Area
Storage
CHANGE OF USE FROM
TO
Area of Decks
Finished Basement
Unfin. Basement
6.
n�
TYPE EW ❑ ALT. 1:1AD'N. 1:1 RPL. 11MVE.
W
No. Baths
No. Stories
No. Rooms
No. of Dwellings
7, OF ❑ OTHER
El BLD. 1-1PLMB. EC H. ElM.H. 1:1 POOL
CERTIFICATE
Req'd.
Recd.
Not Re q'd.
WORK
of EXEMPTION
D SCRIBE WORK Q
8• /75^UOD 671-L
Enum. Dist. Location (Area)
FEES COLLECTED
�/ UATION
!�
��
SOURCE
OF
GAS
ELECTRIC
WATER
SEWER
Ownership
USE CODE
9.
UTILITIES
Public ❑Private ❑
Single $
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
Building
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 -Plumbing
V
DATE OF APPLICATION SIGNATURE OF APPLICAN
Mech.
SPECIAL APPROVALS
S ECIAL CONDITIONS:
NAME DATE
Env. Health
�j 7 1�
I '� `ctv s ' " J
Plan Check
SEPA
Planning
r7e,w
Fire Marshall 1 Mobile Home
I4 .fV
Co. Engineer / Other (Specify)
,Jv
Utilities
Plans Examiner
SEPA Checklist
n _ PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
PERMIT NUMBER
04* *1900
*19.00
* 1 9,006
A *000 "
3057
0 4 --_P, 1
6479:
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
t i
0 k 6 0`8.1 3 0:5. 8 z
DATE ISSUFD PFRMIT No
*19.00 0,-
TnTA I
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