1980, 04-22 Permit: 80-3785 Plumbing FixturesPLAN NUMBER
APPLICATION/ PERMIT
SPOKANE COUNTY - BUILDING CODES DEPARTMENT
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
PERMIT NUMBER
k 3�1
DATE
l >':
l:' n
2 _
A G 7 Q
DESCRIBE WORK i
APPLICANT:
COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 4 COPIES
VALUATION S r c e GAS ELECTRIC WATER SEWER
JOB ADD ESS
B A
f
9. ilities
Single $
I hereby certify that I have read and examined this application and have read the "NOTICE" provisions included
LEGAL DESCRIPTION - SEE ATTACHED
1.
type of work will be complied with whether specified herein or not. The granting of a permit does not presume
lC
a�
performance of construction.
Plumbing
f l
LOT
BLOCK
Mech.
SPECIAL APPROVALS SPECIAL CONDITIONS:
DEPT. REQ'D. RECD.
PARCEL NUMBER/S
2.
ISUBDIVISION
Planning
_
Fire Marshall
Mobile Home
Co. Engineer
O ER
+
Utilities
PHONE
3Q,, V
TOTAL $ (�
3.
WHEN MACHINE VALIDATED IN THIS SPACE,
SEPA Checklist
THIS BECOMES A PERMIT.
DATE FFICIAL
ADDRESS
ZIP
Required Set Backs in Feet
North South
East West
C NTRACT R
/
PHONE
Size of Parcel
Zone Classification
V/L
4'
AD /DRESS
G
ZIP
Type Const.
Occupancy
Sprinklered
C 6
U
(�'�.
❑Yes ❑No ❑ Req'd.
DESIGNER
PHONE
Valuation
Building Area in Sq. Ft.
5'
ADDRESS
ZIP
DWL Area
Basement Area
Garage Area
Storage
CHANGE OF USE FROM
TO
Split Entry
Split Level
Rancher
6.
TYPE
❑ALT.
El AD'N.
C1 RPL.
El MVE.
No. Baths
No. Floors
No. Rooms
Rec. Room
7,
OF
ElOTHER
El BLD.
LMB.
El MECH:
El M.H.
❑POOL
CERTIFICATE
Req'd.
Recd.
Not Req'd.
WORK
of EXEMPTION
PERMIT NUMBER
k 3�1
DATE
l >':
l:' n
2 _
A G 7 Q
DESCRIBE WORK i
8
FEES COLLECTED
VALUATION S r c e GAS ELECTRIC WATER SEWER
f
9. ilities
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. The granting of a permit does not presume
to give authority to violate or cancel the provisions of any other state or local law regulating construction or the
performance of construction.
Plumbing
f l
DATE SIGNATURE
Mech.
SPECIAL APPROVALS SPECIAL CONDITIONS:
DEPT. REQ'D. RECD.
Plan Check
Env. Health
SEPA
Planning
_
Fire Marshall
Mobile Home
Co. Engineer
Other (Sp 3,0�
Utilities
3Q,, V
TOTAL $ (�
Zone Clearance
WHEN MACHINE VALIDATED IN THIS SPACE,
SEPA Checklist
THIS BECOMES A PERMIT.
DATE FFICIAL