1981, 01-06 Permit: 81A-0092 Plumbing FixturesPLAN•TJUM8EP.
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
LOT
BLOCK
S 3/07 bOoccOrv,cc
SUBDIVISION
2.
3 �//1r/�'jjd 1�/�
OWNEYA_� �p
ADDRESS,1 /.161L) /9 tl
CO
'' R ESS C����rk
SIGNER
LEGAL DESCRIPTION - SEE ATTACHED
PARCEL NUMBER/S
PHONE
ZI P
PHONE��//__ /,, r
Actual Set Backs in Feet
North 'South East 'West
Size of Parcel Zone Classific tion
Type Const.
Occupancy Sprinklered
Elves ❑No ❑ Req'd.
PHONE
Valuation
Building Area in Sq. Ft.
5. ADDRESS
ZI P
Main Floor I Upper Floors
Garage Area
Storage
CHANGE OF USE FROM
6.
TYPE
7. OF
WORK
TO
Area of Decks
Finished Basement
Unfin. Basement
)(NEW ❑ ALT. ❑ AD'N. ❑ RPL. ❑ MVE.
❑ BLD. )4-'PLMB. ❑ MECH. ❑ M.H. 0 POOL
❑ OTHER
No. Baths
No. Stories
No. Rooms
No. of Dwellings
CERTIFICATE
of EXEMPTION
DESCRIBE WORK
8.
/ 7
Enum. Dist.
ILocation (Area)
Req'd.
Rec'd.
Not Req'd.
VALUATION
SOURCE
OF
UTILITIES
S
ELECTRIC
WATER
SEWER
Ownership
Public ❑ Private ❑
USE CODE
9.
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 r•gulating construction or the
performance of construction. EE RE ERSE SIDE FOR REQUIRED INSPEC ON /
/
DATE OF APPLICATION ` SIGNATURE OF APPLICA iv•4.11142
SPECIAL APPROVALS
NAME DATE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
Bui - ng Te - ian
SPECIAL CONDITIONS:
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
FEES COLLECTED
Single $
Building
Plyibing ov
Mech.
Plan Check
SEPA
Mobile Home
-00
Other (Specify) '- I
-7 00
TOTAL $
PERMIT NUMBER
03*
A
* 7300
* 73.00
* 73.006
*0.00
912
01-06-81
6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
01'46.41'.
DATE ISSUED
9.2' Z *7 3."O OCL
PERMIT NO. T TAI