1980, 04-08 Permit: 80-3195 Plumbing FixturesPLANT UMt3ER
APPLICATION/PERMIT
SPOKANE COUNTY - BUILDING CODES DEPARTMENT
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 4 COPIES
JOB ADDRESS
1.
2.
3
4.
j�K UBDI/ ��
LOT B IS`ION
LEGAL DESCRIPTION - SEE ATTACHED
5.
OWN ER
ADDRESS/
CONTRACTOR ^v//
ADDRESS
� - /6 ( o 3 .�• 4.6
DESIGNER
PHONE
7 -/732
PARCEL NUMBER/S
Required Set Backs in Feet
North 'South
East
'West
PHONE
.i,2 .73,/
ZIP
,),...2a6
PHONE
Size of Parcel
Type Const.
Valuation
Occupancy
Zone Classification
Sprinklered
Dyes No ❑ Req'd.
Building Area in Sq. Ft.
ADDRESS
ZIP
DWL Area I Basement Area Garage Area
Storage
CHANGE OF USE FROM
6.
TO
Split Entry
Split Level
Rancher
7.
TYPE
OF
WORK
LI NEW
❑ BLD.
❑ ALT. iKAD N.
XPLMB. ❑ MECH:
❑ RPL. ❑ MVE.
❑ OTHER
❑ M.H. ❑ POOL
No. Baths
No. Floors
No. Rooms
Rec. Room
CERTIFICATE
of EXEMPTION
Req'd-
Rec'd.
Not Req'd.
DESCRIBE WORK
8.
VALUATION
9.
./C1 -1.t" rune
Source
of
Utilities
GAS
ELECTRIC
WATER
SEWER
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.
DATE / -� SIGNATURE �---br�
DEPT.
SPECIAL APPROVALS
REQ'D. RECD.
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Zone Clearance
SEPA Checklist
SPECIAL CONDITIONS:
/-71- 7- Fe
DATE OFFICIAL
f
APPROVED FOR ISSUANCE
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL $ .CZJ
PERMIT NUMBER
FO -3/95
DATE 7 gQ
G3*
E
319.4g
* 13.00
* 13.00
* 13.0N`,
R
*O.0Q
04=08=80
g 6479,
LO
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
r ; D_
1, 9,5 Z
*15.00°H