1980, 04-17 Permit: 80-3621 Plumbing Fixtures PLAN NUMBER, APPLICATION/PERMIT PERMIT NUMBER
SPOKANE COUNTY — BUILDING CODES DEPARTMENT
NORTH 811 JEFFERSON / SPOKANE,WASHINGTON 99260 / (509) 456-3675 DATE
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 4 COPIES
03 * * 23. 50
JOB DDRR S ,// .e.,e, LEGAL DESCRIPTION — SEE ATTACHED * 2 3,5 0
L (�1yBLOCK SUBDIVISION PARCEL NUMBER/S * 2 3,5 0
2.
/►�vE.R � - PHONE E * O.O c
3. ` ` t....6, (e5 3620
ADDRESS ZIP Required Set Backs in Feet
North 'South East (West (0 4- 1 7-8 0
CONT/ r.i. United .PI-IOI�1E0� Size of Parcel Zone Classification
4. AD`1(AS / ��� Type Const. Occupancy Sprinklered(n�� ^� / ❑Yes ❑No ❑ Req'd.
SIGNER [ 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.
No. Baths No. Floors No. Rooms Rec. Room
TYPE ❑ NEW ❑ ALT. 0 AD'N. 0 RPL. 0 MVE.
7, OF 0 OTHER
WORK 0 BLD. 0 PLMB. 0 MECH: 0 M.H. 0 POOL CERTIFICATE Req'd. Rec'd. Not Req'd.
of EXEMPTION
DESCRIBE WORK
8. 8 5,_/ ire, FEES COLLECTED
VALUATION Source �- GAS ELECTRIC WATER SEWER
of
9. 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. The ranting of a permit does not presume
to give auth rity to violate or cancel the provisions of any other sta r I cal law regulatin construction or the ? �rd0
performanc of con truction. Plumbing
DATE , i S SIGNATURE Mech.
SPECIAL APPROVALS SPECIAL CONDI IONS:
DEPT. REQ'D. REC'D. Plan Check
n
Env.Health rr:
SEPA i-
U
w
Planning — 2
Mobile Home (/)
Fire Marshall �-}-� —
Co. Engineer Other (Specify) 3 v
Utilities 2
TOTAL $2-3. 0
Zone Clearance
WHEN MACHINE VALIDATED IN THIS SPACE,
SEPA Checklist THIS BECOMES A PERMIT.
DATE OFFICIAL - u I..-
APPROVED FOR ISSUANCE _