1980, 05-28 Permit: 80-5055 Plumbing FixturesPLAN NUMBER
APPLICATION/ PERMIT
SPOKANE COUNTY — BUILDING CODES DEPARTMENT
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
PERMIT NUMBER
DATE
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 4 COPIES
)3e_ n{`
r
JOB ADDRESS
LEGAL DESCRIPTION — SEE ATTACHED
1 /
r
LOT
I BLOCK
ISUBDIVISION
PARCEL NUMBER/S
2.
L Q!
OWNER
PHONE
3.
ADDRESS
ZIP
Required Set Backs in Feet
North South
East West
C F G
CONTRACTOR
P ONE
Size of Parcel
Zone Classification
J 5
���Z
6 4 7 9,
4. ADDRESS j�
k
ZIP
Type Const,
Occupancy
Sprinklered
17 t26 r` V e �"�
❑Yes ❑No ❑ Req'd.
PHONE
Valuation
Building Area in Sq. Ft.
S3 &
5. .L
—
ADP S
ZIP
DWL Area
Basement Area
Garage Area
Storage
nX �
CHANGE OF USE FROM
TO
Split Entry
Split Level
Rancher
6.
TYPE �W 11 ALT. El AWN. 1-1 RPL. ElMVE.
No. Baths
No. Floors
No. Rooms
Rec. Room
7, OF rrs�//❑ OTHER
ElBLD. XPLMB. ❑ MECH: ❑ M. H. ❑ POOL
CERTIFICATE
Req'd.
Recd.
Not Req'd.
WORK
of EXEMPTION
I
DESCRIBE WORK /�
FEES COLLECTED
8• / /— I x f C S
VALUATION
Source
GAS
ELECTRIC
WATER
SEWER
9.
of
utilities
Single $
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
Building
type of work will be complied with whether specified herein or not. Th anting of a permit does not presume
to give authority to violate or cancel the provisions of any other state regulati cons ction or the
�
performanc of construction.
DATE SIGNATURE
Plumbing ,E�
_
Mech.
SPECIAL APPROVALS SPECIAL O DITIONS:
DEPT. REQ'D. RECD.
Plan Check
Env. Health
SEPA
Planning
Fire Marshall
Mobile Home
Co. Engineer
Other (Specify)
Utilities
TOTAL $
Zone Clearance
WHEN MACHINE VALIDATED
IN THIS SPACE,
SEPA Checklist
THIS 13E,COMES A PERMIT.
U J��— ,� 8
DATEFFICIAL
_