1980, 08-19 Permit: 80-8737 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
JOB ADDRESS
LOT
2.
BLOCK
/fao g /viclx /,vel/
SUBDIVISION
LEGAL DESCRIPTION - SEE ATTACHED
3.
OWNER
ADDRESS
PHONE
ZIP
PARCEL NUMBER/S
Actual Set Backs in Feet
North 'South East 'West
4.
5.
6.
CONTRACTOR
PHONE
Size of Parcel I Zone Classification
ADDRESS
DES/ ec/ellaa-
ADDR %7 /D-
CHANGE OF USE FROM
TO
ZIP
ZIP
Type Const.
Occupancy,
Spnnklered.
❑Yes ONo 0 Req'd.
Valuation (Building Area in Sq. Ft.
Main Floor
Upper Floors 1 Garage Area
Area of Decks
Finished Basement
Storage
Unfln. Basement
7.
TYPE
OF
WORK
NEW xxgtt0s��rr ALT. 0 AD N. 0 RPL. 0 MVE.
BLD. pJ PLM B. 0 MECH. 0 M.H. 0 POOL
/�/r. Ain4 vns //
DESCRIBE WORK
8.
0 OTHER
No. Baths
No. Stories
No. Rooms
No. of Dwellings
CERTIFICATE
of EXEMPTION
Req'd.
Rec'd.
Not Req'd.
Enum. Dist. I 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 -rmit does not presume
to give authority to violate or cant 1 the provisions of any other state or local law re ing.construction or t
performance of construction. SEE$EVERSE SIDE FOR REQUIRED INSPECTION
DATE OF APPLICATION
'- SIGNATURE OF APPLICANT
SPECIAL APPROVALS / SPECIAL CONDITIONS:
NAME DATE
Env. Health
Planning
Fire Marshall
•
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
FEES COLLECTED
Single $
Building 2�I
"
Plumbing dv
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL
s vO
0
de PERMIT NUMBER
03* *30.50
*30.50
*3Q506
E "*Q00 8
873.21
08-19-80
2 61179.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
p18;11�9'",;810' 87�37'Z :*30,5.0.
DATE ISSUED PERMIT NO. • TOTAL