1980, 06-12 Permit: 80-5689 Plumbing FixturesPLAN jUERS - APPLICATION/ PERMIT
(/�,J���- SPOKANE COUNTY - BUILDING CODES DEPARTMENT
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 4 COPIES
JOB ADDRESS
Itl�— Iq,,� Q a �� LEGAL DESCRIPTION — SEE ATTACHED
LOT BLOCK SUBDIVIS N I PARCEL NUMBER/S
2.
FEES COLLECTED
North South
East West
Size of Parcel
Zone Classification
OWNER ,
Type Const.
PHONE
3.
�I;r
❑Yes ❑No ❑ Req'd.
I
Valuation
Building Area in Sq. Ft.
DRES
DWL Area
ZIP
Garage Area
Storage
�lD
to give authority to violate or cancel the provisions of any other state or I law reguion or thei
Split Entry
CONTRACTOR
Rancher
PHONE
4.D
— �✓D®:
SPECIAL APPROVALS SPECIAL CONDITIONS:
No. Floors
No. Rooms
AD RESS
zsevr2ao
Env. Health
ZIP
DESIGNER
LBa
FICATE
Req'd.
PHONE
5.
MPTION
Other (Specify)
ADDRESS
ZIP
CHANGE OF USE
FROM
TO
6.
TYPE ❑ NEW
El ALT. ElAD'N. 1:1 RPL.
❑ MVE.
%
OF
OTHER
❑ BLD.
❑ PLMB. ❑ MECH: E-1 M.H.
El❑ POOL
WORK
Required Set Backs in Feet
FEES COLLECTED
North South
East West
Size of Parcel
Zone Classification
WATEWER
Type Const.
Occupancy
Sprinklered
❑Yes ❑No ❑ Req'd.
I
Valuation
Building Area in Sq. Ft.
DWL Area
I Basement Area
Garage Area
Storage
type of work will be complied with whether specified herein or not. The granting of at presume
to give authority to violate or cancel the provisions of any other state or I law reguion or thei
Split Entry
Split Level
Rancher
DATE SIGNATURE
Mech.
SPECIAL APPROVALS SPECIAL CONDITIONS:
No. Floors
No. Rooms
Rec. Room
Env. Health
SEPA
LBa
FICATE
Req'd.
Recd.
Not Re(
MPTION
Other (Specify)
8. ems/
fW, // / fT]4e
FEES COLLECTED
VALUATION
Source
GAS
ELECTRIC
WATEWER
9.
of
Utilities
Single $
I hereby certify that I have read and examined this application and have read the "NOs included
on reverse side, and know the same to be true and correct. All provisions of laws andrning this
Building
type of work will be complied with whether specified herein or not. The granting of at presume
to give authority to violate or cancel the provisions of any other state or I law reguion or thei
performance ofconstruction.
Plumbing
DATE SIGNATURE
Mech.
SPECIAL APPROVALS SPECIAL CONDITIONS:
DEPT. REQ'D. RECD.
Plan Check
Env. Health
SEPA
Planning
Fire Marshall
Mobile Home
Co. Engineer
Ut —
Other (Specify)
(((es -
TOTAL $
Zone Clearance
SEPA Checklist
DATE 4/)21 OFFICIAL"I
PERMIT NUMBER
DATE
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES�A PERMIT.
it.. ...
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES�A PERMIT.