1980, 11-17 Permit: 80B-3838 Plumbing FixturesPLAN NUMBER
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
2.
JOB ADDRESS
LOT (L/!1SU8.af/QIVISION
LEGAL DESCRIPTION - SEE ATTACHED
PARCEL NUMBER/S
OWNER s
3. /'t!/ l(J4/(.r �7G/
ADDRESS
CON ACTOR / ' %
a. AD.eiaA� L US JLjJ4,T ('r #W t
irES9:5400 4io�,�
DES( ER
5. eo JMsc) z4' t • 3 0c
A bR-ES30
PHONE
ZIP
Actual Set Backs in Feet
North • (South
East
'West
PHONE
.-260/
Slee of Parcel
Zone Classification
ZIP
Type Const.
Occupancy
Sprinklered
❑Yes ONo 0 Req'd.
PHONE
Valuation
Building Area In Sq. Ft.
W3o
Main Floor
Upper Floors Garage Area
Storage
6.
CHANGE OF USE FROM
t
TO
Area Of Decks
Finished Basement
Unfln. Basement
TYPE «NEW
7. OF
WORK 0 BLD.
❑SALT. ❑ AD'N.
-iE PLMB. 0 MECH.
❑ RPL.
❑ M.H.
❑ MVE.
0 POOL
0 OTHER
NO. Baths
No. Stories
No. Rooms
No. of Dwellings
CERTIFICATE
of EXEMPTION
Req'd.
Re 'd.
Not Req'd.
DESCRIBE WOR / /g
B. P/1:- x teS
Enum. Dist.
Location (Area)
VALUATION
9.
SOURCE
OF
UTILITIES
GAS
ELECTRIC
WATER
SEWER
Ownership
Public 0 Private 0
USE CODE
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
to give authority to violate or cancel the provisions of any other state or local law re; lating con ruction or
performance of construction. SE REV RSE SIDE FOR REQUIRED INSPECTION
DATE OF APPLICATION
SPECIAL APPROVALS
NAME DATE,
Env. Health
Planning
Fl re Marshall
Co. Engineer
Utilities
Plans Examine
SEPA Checklis
n
SIGNATURE OF APPLICANT
PECIAL CONDITIONS:
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
FEES COLLECTED
Single
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
3ft°
TOTAL
sfacs
PERMIT NUMBER
`&c -3v3n
r
i
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
11;11; ai8 01
DATE.ISSUED
,i
3.8!,33:d• *35.00a.l''-'
TOTAL
PERMIT NO.
•