1981, 02-04 Permit: 81A-1165 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
/116 ��� LEGAL DESCRIPTION —SEE ATTACHED
OWNER n
PHONE
3. CrJterL--@%
ADDRESS
ZIP
Actual Set Backs in Feet
Q!27,;UNorth
South
East West
CONTRACTOR
PHONE
Size of Parcel
Zone Classification
C7.2 -7 I
4. ADDRESS"ZIP
Type co;7
Occupancy
Sprinklered
!� c�
Dyes ❑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 ❑ NEW ❑ ALT. ❑ AD'N. El RPL. El MVE.
7, OF ❑OTHER
❑ BLD. (o PLMB. ❑ MECH. ❑ M.H. ❑ POOL
CERTIFICATE
Req'd.
Recd.
Not Req'd.
WORK
of EXEMPTION
ESQRIB WORK
Enum. Dist.
Location (Area)
FEES COLLECTED
8
VALUATION
SOURCEf
GAS
ELECTFkIC
WATER
SEWER
Ownership
USE Cjed
9.
OF
UTILITIES
Public ❑ Private C31
Single $
1 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 governingBuilding
type of work will be complied with whether specified herein or not. The granting of a permit does not pres
to give authority to violate or cancel the provisions of any other state or local law regulating construction orme
f
performance of construction. SEE REVERSE SIDE FOR REQUIRED INSPECTIONS
Plumbing
DATE OF APPLICATION 2S— / '�j SIGNATURE OF APPLICANT
Mech.
SPECIAL APPROVALS
SPECIAL CONDITIONS:
NAME DATE
Plan Check
Env. Health
Planning
Q
! .✓i(,�-�'
SEPA
Fire Marshall / Mobile Home
Co. EngineerOther (Specify)
Utilities
Plans Examiner
SEPA Checklist
Buhlding Tecnfician/7
i
PERMIT IS NONTRANSFERABLE
PERMIT NUMBER
/0 F/A-ir4/r,,s-
TOTAL
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
'0 Z-0 4-g,1 110 z
*210,01ffNJ- -