1980, 12-16 Permit: 80B-4908 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
1.//0#0
LOT //0#0
LOT BLOCK SUB (VISION
2.
LEGAL DESCRIPTION — SEE ATTACHED
OWNER
3. ko Tel
ADDRESS
6.. ivIZG
CON T•'
i7 i> or
5.
ADDF 4./P77/
74)
4. ADDRES
D ESIG ER
CSD. , X7y01
Cow s Tftt,LCT e ory
PHONE
R Z 8—t14R
PARCEL NUMBER/S
V62rLc=7
ZIP
2aL
Actual Set Backs in Feet
North (South `East 'West
PHONE
%9-7376
Size of Parcel (Zone Classification
ZIP
�gzi¢
PHONE
Type Const.
Occupancy
Sprinklered
❑Yes ❑No ❑ Req'd.
Valuation Building Area in Sq. Ft.'
CHANGE OF USE FROM
6.
TYPE f® NEW
7. OF
WORK /sg. BLD.
DESCRIBE WORK
8.
ZIP
Main Floor
Upper Floors 1 Garage Area
Storage .
TO
Area of Decks
Finished Basement
Unf in. Basement
VALUATION
9.
❑ ALT. 0 AD N. 0 RPL. 0 MVE.
RtPLMB. 0 MECH. 0 M.H. 0 POOL
/
GAS
SOURCE
OF
UTILITIES
ELECTRIC
WATER
❑ OTHER
No. Baths
No. Stories
No. Rooms
No. of Dwellings
CERTIFICATE
of EXEMPTION
Req .
Rec'd.
Not Req'd.
Enum. Dist.
Location (Area)
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 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 INSPECTIONS
JhP'Y Au..L t+ 6 -a -
DATE OF APPLICATION /ViClc% SIGNATURE OF APPLICANT
SPECIAL APPROVALS
NAME DATE
Env. Health
Planning
Fire Marshall
Co. Engineer
Ut 11 it les
Plans Examiner
SEPA Checklist
SPECIAL CONDITIONS:
74.47
AA
L
ofl$ a .
Building Technician
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE DATE ISSUED - PERMIT NO. TOTAL
FEES COLLECTED
Single $
Building
Plumbing'
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL $ 14:1442- 7 f�
(PERMIT NUMBER
P o 4,08
03.* *4aoo
*4aoo
*4x00'6
A *Q00 8
4'9Q72
12-16-80
2 6479.
1
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
lit HI's
air
49M.81_ +►48,00 °a� -
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