1980, 03-13 Permit: 80-2221 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 4 COPIES
1.
2.
3.
JOB ADDRESS
LO LOCK SUBDIVISION �� 0�
LEGAL DESCRIPTION — SEE ATTACHED
PARCEL NUMBER/S
OWNF,R
ADDRESS
PHONE
ZIP
Required Set Backs in Feet
North. 'South (East 'West
CONTRACT R ��----'�
AD7! E V 7 L I 1-e-yrtJ�
PHONE
e 90/2
Z gzoI
Size of Parcel 1 Zone Classification
Type Const.
Occupancy
Sprinklered
Des ❑No ❑ Req'd.
DESIGNER
5' ADDRESS
PHONE
Valuation (Building Area in Sq. Ft.
ZIP
DWL Area I Basement Area ( Garage Area
Storage
CHANGE OF USE FROM
6.
TYPE
7. OF
WORK
TO
Split Entry
Split Level
Rancher
NEW
❑ BLD.
❑ ALT.
0 PLMB.
❑ AD'N.
❑ MECH:
O RPL.
O M.H.
❑ MVE.
❑ POOL
0 OTHER
No. Baths
No. Floors
No. Rooms
Rec. Room
CERTIFICATE
of EXEMPTION
Req'd.
Recd.
Not Req'd.
DESCRIBE WORK
8.
VALUATION
9.
Source
of
Utilities
GAS
ELECTRIC
WATER
SEWER
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 = - - • this
type of work will be complied with whether specified herein or not. The granting .f a •er :oes not pres e
to give authority to violate or cancel the provisions of any other state or .cal I re at
performance of cons ruction.
DATE c,
DEPT.
SPECIAL APPROVALS
REQ'D. REC'D.
SIGNATUR
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Zone Clearance
SEPA Checklist
SPECIAL CONDITIONS:
27
DAT �� FF I C I A L (-6C .AAAAZSYZ
FEES COLLECTED
Single $
Building
Plumbing 27 So
Mech.
Plan Check
SEPA
Mobile Home
0 e (Specify)
er
TOTAL
E
3- 1 =-? l
1i7C
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.