1979, 09-18 Permit: 79-4200 Plumbing FixturesPLAN NUMBER
APPLICATION/ PERMIT
SPOKANE COUNTY — BUILDING CODES DEPARTMENT
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
TYPE NEW ❑ ALT. ❑ AD'N. ❑ RPL. ❑ MVE.
APPLICANT:
COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 4 COPIES
JOB ADDRESS
7. OF ❑ OTHER
LEGAL DESCRIPTION - SEE ATTACHED
1. - .ar3/
O rd!
O
CERTIFICATE
LOT
BLOCK
SUBDIVISION
❑ BLD. ❑ PLMB. ❑ MECH: ❑ M.H. ❑ POOL
PARCEL NUMBER/S
2.
I
DESCRIBE WORK
• �st'�S
OWNER
s. v�� i
PHONE
VALUATION
Source
GAS
ELECTRIC
WATER
SEWER
9.
Utilofities
ADDRESS'/
Single $
ZIP
Required Set Backs in Feet
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 Building
type of work will be complied with whether specified herein or not. The granting of a permit does not presume
North South East West
CONTRACTOR
PHONE
Size of Parcel
Zone Classification
DEPT. REQ'D. RECD.
Plan Check
Env. Health
4.
Planning
Mobile Home
Fire Marshall
DDRES
Other (Specify)
ZIP
Type Const.
Occupancy
Sprinklered
,J
❑Yes ❑No ❑ Req'd.
DESIGNER
PHONE
Valuation
Building Area in Sq. Ft.
5.
ADDRESS
ZIP
DWL Area
Basement Area
Garage Area
Storage
CHANGE OF USE FROM
TO
Split Entry
Split Level
Rancher
6.
No. Baths
No. Floors
No. Rooms
Rec. Room
TYPE NEW ❑ ALT. ❑ AD'N. ❑ RPL. ❑ MVE.
7. OF ❑ OTHER
CERTIFICATE
Req'd.
Recd.
Not Req'c
❑ BLD. ❑ PLMB. ❑ MECH: ❑ M.H. ❑ POOL
WORK
of EXEMPTION
I
DESCRIBE WORK
• �st'�S
FEES COLLECTED
s. v�� i
VALUATION
Source
GAS
ELECTRIC
WATER
SEWER
9.
Utilofities
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 Building
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
Plumbing
performance of construction.
DATE SIGNATUREMech.
SPECIAL APPROVALS SPECIAL CONDITIONS:
DEPT. REQ'D. RECD.
Plan Check
Env. Health
SEPA
Planning
Mobile Home
Fire Marshall
Co. Engineer
Utilities
Other (Specify)
DATE
PERMIT NUMBER
03* *25.50
*2550
*25.50
E *0.00
41 9,9z2
09-18-79
g 6,479,
TOTAL ssa7' .So
Zone Clearance
WHEN MACHINE VALIDATED IN THIS SPACE,
SEPA Checklist C r THIS CO AMIT. 1
[� —1 420.025
DATE OFFICI
*25.5000�--'—
DAT E REMARKS
RECORD OF INSPECTIONS
Final ImintLon
INSPECTED NT