1980, 09-11 Permit: 80-9996 Plumbing FixturesPLAN NUMBER
? "IC APPLICATION/PERMIT
SPOKANE COUNTY - BUILDING CODES DEPARTMENT
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
PPLICANT: COMPLETE NUMBERED SPACES - PREh HARD TO MAKE 4 COPIES
JOB ADDRESS
LOT
g
BLOCK
SUBDIVISION
OWNER
/� % 7
3. f -J .f%� A`/ e % t1 !c 42_‘A.
ADDR€SS
J M -Z
PHONE
916 �
LEGAL DESCRIPTION - SEE ATTACHED
PARCEL NUMBER/S
CONTRACTOR
ADDRESS
PHONE
Required Set Backs in Feet
North (South (East (West
Size of Parcel 1 Zone Classification
ZIP
Type Const.
Occupancy
Sprinklered
Eyes EINo ❑ Req'd.
DESIGNER
ADDRESS
CHANGE OF USE FROM
6.
TO
PHO E
ZI P
Valuation
Building Area in Sq. Ft.
DWL Area
Basement Area
Garage Area
Storage
Split Entry
Split Level
Rancher
TYPE
7. OF
WORK
8.
9.
❑ NEW
❑ BLD.
DESCRIBE WORK
VALUATION
❑ ALT.
❑ PLMB.
54 AD N.
❑ MECH.
Source
of
Utilities
❑ RPL.
❑ M.H.
j
❑ MVE_
❑ POOL
❑ OTHER
No. Baths
No. Floors
No. Rooms
Rec. Room
GAS
ELECTRIC
WATER
CERTIFICATE
of EXEMPTION
SEWER
Req'd.
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 construc ;on or e
performance of construction.
DATE 7` O /f ''
SIGNATURE
DEPT.
SPECIAL APPROVALS
REQ'D. REC'D.
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Zone Clearance
SEPA Checklist
SPECIAL CONDITIONS:
DATE
-rr_o vvN'CI�
/I
OFFICIAL
APPROVED 'IR ISSUANCE
Recd.
Not Req'd.
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL
$ /�•�
p
DATE
PERMIT NUMBER
4.
03* *1050
* 1050
* 10506
A *000 S
99952
09-11-80
2 6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOM ..,PERMIT.
999.62
*10,5,0°