1981, 08-03 Permit: 81A-7696 Gas PipingPLAN 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
JOW:DRIE e j scrod
LOT BLOCK UBDIVISION
2.
tat—
LEGAL DESCRIPTION - SEE ATTACHED
3.
4.
5.
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CO
ADDRESS
DESIGNER
ADDRESS
R ESS
PHO E
�L�- 202 -
PHONE
ZIP
PARCEL NUMBER/S
Actual Set Backs'in Feet II
North 'South 1East IWest
Size of Parcel ''Zone Classification
Type Const.
Occupancy Sprinklered
❑Yes CNo 0 Req'd.
PHONE
Valuation 1 Building Area in Sq. Ft.
ZIP
Main Floor
Upper Floors 1 Garage Area
Storage
CHANGE OF USE FROM
6.
TYPE
7. OF
WORK
TO
Area of Decks
Finished Basement
Unfin. Basement
Id'NEW
0 ALT. 0 AD N. 0 RPL. ❑ MVE.
0 BLD. 0 PLMB. a/MECH. 0 M.H. 0 POOL
0 OTHER
No. Baths
No. Stories
No. Rooms
No. of Dwellings
CERTIFICATE
of EXEMPTION
Req'd.
Recd.
Not Req'd.
8. DE tkI WOR I I V ( 1") I I )
VALUATION GAS
9.
WURCE
OF
UTILITIES
Enum. Dist.
Location (Area)
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 regulating construction or the
performance of construction. SEE REVERSE SIDE FOR REQUIRED INSPECTIONS
DATE OF APPLICATION
SPECIAL APPROVALS
NAME DATE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
�Builtl Tec an
SIGNATURE OF APPLICAN
SPECIAL CONDITIONS:
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
FEES COLLECTED
Single $
Building
Plumbing
Mech. I �'
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL $ I `
PERMIT t MB tMZ
b1/k-7k:%C°'
04*
' *1200
*1200 17)
769.58
08-03-81
6479.
t
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
0;8 bit1•
13iiL'8v1
DATE ISSUED
-1 _
769.62. *'12r0i0a�,
PERMIT NO. ' 0 AL
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0-
WHEN
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