1981, 04-22 Permit: 81A-3796 Plumbing Fixtures.,LAN NUMBER APPLICATION/PERMIT
SPOKANE COUNTY - BUILDINGS CODES DEPARTMENT
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
U APPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 3 COPIES
JOB ADDRESS LEGAL DESCRIPTION - SEE ATTACHED
�. N. SIG LIL12-nlry
LOT I BLOCK ISUBDIVISION PARCEL NUMBER/S
OWNER
PHONE
3. StUA T1651
ADDRESS
ZIP
Actual Set Backs in Feet
,/
tj 5161 &Lr--tuA.)
�/1
C(C(ZD
•
North South East
West
CONTRACTOR
PHONE
Size of Parcel
Zone Classification
4.
ADDRESS
ZIP
TyPWTo7
Occupancy
Sprinklered
Cj AM15-
I
❑Yes []No ❑ Req'd.
DESIGNER
PHONE
Valuation
Building Area in Sq. Ft.
5.
ADDRESS
ZIP
Main Floor
I Upper Floors
Garage Area
Storage
CHANGE OF USE FROM
TO
Area of Decks
Finished Basement
Unfin. Basement
s.
TYPE NEW C3 ALT. El AD'N. El RPL. El MVE.
[j�
No. Baths
No. Stories
No. Rooms
No. of DWeII7
%. OF ❑OTHER
�
WORK ❑ BLD. PLMB. ❑ MECH. ❑ M.H. POOL
CERTIFICATE
Req'd.
Recd.
Not Req'c
of EXEMPTION
DESCRIBE WORK
Enum. Dist. Location (Area)
8• 3 F IXTuQ
FEES COLLECTED
VALUATION
SOURCEGAS
ELECTRIC
WATER
SEWER
Ownership
USE CODE
9.
OF
I UTILITIES
Public 11 Private ❑
Single $
1 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 gulating construction or the
performance of construction. SEE REVERSE SIDE FOR REQUIRED INSPECTIO
Plumbing
DATE OF APPLICATION/ '
1 SIGNATURE OF APP T
ech.
SPECIAL APPROVALS
SPECIAL CONDITIONS:
NAME DATE
Plan Check
t S4'�6WE'R
Env. Health
1
Planning
i l d 1 LET
SEPA
Fire Marshall
"L LAtvAtCJOzltS
Mobile Home
neer
Utilities
Plans Examiner
ng hchnician — PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
Other (Specify)
TOTAL $ 12 .
PERMIT NUMBER
gf IA- 3xt�
03* * 1 7.00
*1700
379.512
04-22-81
6.479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
t
.04i- 2� 2 -'8 'h 3, 7 9.' 6 12
DATE ISSUED PERMIT NO.
*1ZOO a-�J-
TOTAL