1981, 05-06 Permit: 81A-4415 Gas PipingNUMB
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 t
1. /_ �f' , 18 _,,(U3 �F'i�'�U LEGAL DESCRIPTION —SEE ATTACHED
OWNER •✓If��fl'��M, � M
3.
ADDRESS
6_ l830;�>
A!ad ri
PHONE
ZIP Actual Set Backs in Feet
North South
( PERMIT NUMBER
Y ,5I s
*1a00X
Ai-�
441,4
CONT ACT RG
�OIyET
Size of Parcel
Zone Classification
( — U
VAJ '
�
6.479,
4. AICRESS �1
Z
Type Const. I
Occupancy
Sprinklered
0
❑Yes ❑No ❑ Req'd.
DESIGNER
PHONE
Valuation
Building Area in Sq. Ft.
5'
ADDRESS
ZIP
Main Floor
Upper Floors
Garage Area
Storage
—
CHANGE OF USE FROM
TO
Area of Decks
Finished Basement
Unfin. Basement
6.
No. Baths
No. Stories
No. Rooms
No. of Dwellings
TYPE �,/
LJ NEW ❑ ALT. ❑ AD -N. ❑ RPL. ❑ MVE.
7 El OTHER
❑ BLD. ❑ PLMB. i�MECH. ❑ M.H. ❑POOL
CERTIFICATE
Req'd.
Recd.
Not Req'd.
WORK
of EXEMPTION
DESA E WORK�� )I / 3vl/SII r �I
Enum. Dist. Location (Area)
FEES COLLECTED
8.
VALUATION
SOURCE
GAS
ELECTRIC
WATER
SEWER
Ownership
USE COjh
9.
OF
UTIL TIES
Public ❑ Private ❑
Single $
I hereby certify that I have read and examined this application and have read the "NOTICE" provisions inclu
_
on reverse side, and know the same to be true and correct. All provisions of laws and ordinances governing
type of work will be complied with whether specified herein or not. The granting of a permit does not presuBuilding
to give authority to violate or cancel the provisions of any other state or local law regulating construction or
performance of construction. SEE REVERSE SIDE FOR REQUIRED INSPECTIONS
Plumbing
DATE OF APPLICATION ,� (gyp _ SIGNATURE OF APPLICANT ��
ILT-
Mech.
SPECIAL APPROVALS
SPECIAL CONDITIONS:
NAME DATE
U
Plan Check
Env. Health
SEPA
Planning
Fire Marshall
Mobile Home
Co. Engineer
Other (Specify)
Utilities
f
TOTAL $
Plans Examiner
WHEN MACHINE VALIDATED IN THIS SPACE,
SEPA Checklist
THIS BECOMES A PERMIT.
Buil ecn clan PERMIT IS NONTRANSFERABLE
0 6'',$ 1 4 415 z
* l Z 0, 0 a F.