1981, 05-12 Permit: 81A-4611 Plumbing FixturesPLAN NUMBER
APPLICATION/PERMIT
SPOKANE COUNTY — BUILDING CODES DEPARTMENT
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
s
1.
APPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 3 COPIES
JOB ADDRESS
LOT
2.
BLOCK
��/0 Y110--,c,relI
S BDI ISI N
LEGAL DESCRIPTION - SEE ATTACHED
3 N
OWNER. /� 1 / /� nµ0.1
{) 1/ /L p/,V V
ADDRESS
r;IF7 .t 55,r
CONT[ TOR
4. YN�E,iyiOw �uw/�,v..c5
ADS r, 3c I n I / L �)
VlN ��Jl
DESIGNER
ADDRESS
5.
PHONE
//Y
PHONE
PARCEL NUMBER/S
Actual Set Backs in Feet
North 'South `East (West
Size of Parcel 1 Zone Classification
Type Const.
Occupancy
Sprinklered
Dyes' DNo 0 Req'a.
Valuation 1 Building Area in Sq. Ft.
ZIP
Main Floor
UPPer Floors Garage Area
Storage
CHANGE OF USE FROM
6.
TO
Area of Decks
Finished Basement
Unfin. Basement
TYPE %1EW
7, OF
WORK - D BLD.
D ALT. 0 AD N. 0 RPL. D MVE.
rgs,FILMB 0 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.
DESCRIBE WORK
8.
VALUATION
9.
SOURCE
OF
UTILITIES
Gs
)(4a-r.i5
Enum. Dist. I Location (Area)
ELECTRIC I WATER
SEWER
Ownership
Public D 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 egulating construction or the
performance Of construction. t�/i'J /S `EE REVERSE SIDE FOR REQUIRED INSPECTION
DATE OF APPLICATION w SIGNATURE OF APPLICANT w•si4'(('/''�C./1'L��
SPECIAL 'APPROVALS
` NAME DATE
Env. Health ,
Planning
Fire Marshall
Co. Engineer,:,
i
Utilities
Plans Examiner
SEPA Checklis
SPECIAL 171DITIONS:
Ino r
t- /Di e
/-17;e 5Icer
1" et% -1-ev- a eai4ty'
1- ito2sitv.{
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
FEES COLLECTED
Single $
Building
• Plumbing
Mech.
.Plan Check
SEPA
Mobile Home
ate
'Other (Specify)
TOTAL
PERMIT NU-M28E4 f r
03* *4900
*49.00 ri
*49,006
A *000 8
461.02
0'5-12-8,1
2 6479.
`l
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
0: , 11.12'' 81`h
DATE IS LIED PERMIT NO.
r_•:7. . . . ,t,.,, — - -
46LLI *90.0°n:J -
TOTAL