1980, 04-28 Permit: 80-4005 Plumbing FixturesPLAN NUMBER
APPLICATION/PERMIT
SPOKANE COUNTY — BUILDING CODES DEPARTMENT
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 4563675
APPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 4 COPIES
JOB ADDRESS
LOT
2.
BLOCK
5?5 6 rDx
SUBDI ISI ON
LEGAL DESCRIPTION - SEE ATTACHED
3.
OWNER
PHONE
PARCEL NUMBER/S
ADDRESS
ZIP
Required Set Backs In Feet
North (South
East
(West
CONTR TOR
a.
Clad�� x0051,
e° ra( 4 Pr,
L
vox 1097'
CHANGE OF USE FROM
5. De\E,S
6.
TO
PHONE
gay *WS'
PHONE
Wy
PeZ
Size of Parcel
Zone Classification
Type Const.
Valuation
Occupancy
Sprinklered
Oyes ONo 0 Req'd.
Building Area in Sq. Ft.
DWL Area
•
Split Entry
Basement Area
Garage Area
Split Level
Storage
Rancher
TYPE.
7. OF
WORK
Iq NEW
0 BLD.
0 ALT. 0 AD N.
PLMB. 0 MECH
O RPL.
O M.H.
❑ MVE.
O POOL
0 OTHER
No. Baths
No. Floors
No. Rooms
Rec. Room
CERTIFICATE
of EXEMPTION
Req'd.
Recd.
Not Req'd.
DESCRIBE WORK
8.
/a
VALUATION
9.
Source
of
Utl1It l05
GAS
ELECTRIC
WATER
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 I. s and ordinances governing this
type of work will be complied with whether specified herein or not. The gra of a permit doe not presume
to give authority to violate or cancel the provisions of any other state or lo . jregulatin onstpt ction or the
performanceof constrtion.
DATE q 84 (/
SIGNATURE
DEPT.
SPECIAL APPROVALS
REQ'D. RECD.
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Zone Clearance
SEPA'Checklist
LR0ME OWNER'S WARRANTY
YES ❑
nm n
SPECIAL CO ONS:
•
DATE **OFFICIAL 1 \ 0./LM.A.—nVN
APPROVED FOR ISSUANCE
FEES COLLECTED
Single
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
gg a
TOTAL
PERMIT NUMBER
R -%t -4005
DATE
03* *3300
*3300
*33006;
E *000 8
40043
04=28"-80
6479.
336-0
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
t Wir 0!M 4'13 0.511
"33.0.0 a,i-