1981, 04-14 Permit: 81A-3553 Mechanical 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
1.
LOT
2.
BLOCK
3.
OWNER
ADDRESS
4.
I0IZ_ IMtSSikSn.)
BDIVISION
c i;1 -;A ctivac
c
CONTRACTO
t_
ADDRESS
LEGAL DESCRIPTION — SEE ATTACHED
P ON
ZIP —��
PARCEL NUMBER/S
Actual Set Backs in Feet
North 'South [East 'West
PHONE
Size of Parcel 1 Zone Classification
Zgq a)_1
Type Const.
Occupancy
Sprinklered
❑Yes ❑No 0 Req'd.
DESIGNER
5. ADDRESS
PHONE
Valuation 1Building 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
7. OF
WORK
❑ NEW
❑ BLD.
❑ ALT.L,/AD�'%. ❑ RPL. 0 MVE.
❑ PLMB. L7 MECH. 0 M.H. 0 POOL
DESCRIBE:-1kORK
8. EVALUATIN�OURC
9. a550s TIOIFT
IES
C_cAive,rsiciN
GAS
ELECTRIC
66.1.1NQ
WATER
0 OTHER
No. Baths
No. Stories
No. Rooms
No. of Dwellings
CERTIFICATE
of EXEMPTION
Req'd.
Recd.
Not Req'd.
Enum. Dist.
Location (Area)
SEWER
Ownership
Public 0 Private 0
USE CODE
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 regulating construction or the
performance of construction. SEE REVERSE SIDE FOR REQUIRED INSPECTION
DATE OF APPLICATION 13t SIGNATURE OF APPLICANT
SPECIAL APPROVALS
NAME DATE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
Bu i Iding'Y,9EhnTCjan
SPECIAL CONDITIONS:
Qi?C_
g+Gi
r
`o J
v Pir tx,"1-11 30 I
PERMIT IS NONTRANSFERABLE
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL $
PERMIT NUMBER
t
—
0 * *1900
*1n,_0 ,17)
*1900'
A * 0 '0
355'
0 li 1 4— 8 1
6.47'9.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
35`5.3d *19.0021 -