1980, 12-16 Permit: 80B-4918 Plumbing Fixturesir,i-‘1,4 iNVIVIllt.11
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
1.
2.
S 6� ,//e/ati
BL K SUBDIVISION
/-
LEGAL DESCRIPTION — SEE ATTACHED
3.
4.
5.
OWNER
r /°/z •
DO
c alk -1'2
C• RACTOR
PARCEL NUMBER/S
DESIGN
V 30 7�(f .,,,/
/' i%/ISS. ji>1
PHONE
X35- 987@
ZIP
7741 4-
PHONE
Actual Set Backs in Feet
North 'South
Size of Parcel
Type Const. I Occupancy
Valuation
East
(West
Zone Classification
Sprinklered
❑Yes ❑No 0 Req'd.
Building Area in Sq. Ft.
ADDRESS
ZIP
Main Floor
Upper Floors 1 Garage Area
Storage
CHANGE OF USE FROM
6.
TYPE
7. OF
WORK
TO
❑ ALT. ❑ AD N.
PLMB. 0 MECH.
❑ RPL.
❑ M.H.
❑ MVE.
❑ POOL
0 OTHER
Area of Decks
No. Baths
Finished Basement
No. Stories
No. Rooms
Unfin. Basement
No. of Dwellings
CERTIFICATE
of EXEMPTION
Req'd.
Rec'd.
Not Req'd.
8. DESCRIBE WORK /a : "17,774 , �S
VALUATION
9.
Enum. Dist.
ILocation (Area)
SOURCE
OF
UTILITIES
GAS
ELECTRIC
WATER
SEWER
Ownership
Public 0 Private 0
USE CODE
I hereby certify that 1 have4raad 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 violet or cancel the provisions of any other state or local law regulating construc i' or the
performance of construction. SEE REVERSE SIDE FOR REQUIRED INSPECTII
DATE OF APPLICATION (Tit SIGNATURE OF APPLICAN
SPECIAL APPROVALS SPECIAL CONDITIONS:
NAME DATE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
7 74
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PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
FEES COLLECTED
Single $
Building /�''i,,��,,,,���
Plumbing �Z.SL43.�
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL
$
r
PERMIT NUMBER
&C) -et, 16
03* *4800
* 48.00
* 48,00y
n8
*Out.
491,7
12-16-80
6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
12,=16-'8'0
DATE ISSUED
49181 *4 &0.02 —
TOTAL
PERMIT NO.