1981, 02-11 Permit: 81A-1371 Plumbing FixturesPLAN NUMBER
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APPLICATION/PERMIT
SPOKANE COUNTY — BU1LDIN13 CODES DEPARTMENT
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 3 COPIES
JOB ADDRESS _
LEGAL DESCRIPTION - SEE ATTACHED
LOT
2.
BLOCK
SUBDIVISION
3.
OWNER
a)Y6
PHONE
PARCEL NUMBER/S
ADDRESS
7 74- 6 r
ZIP
477ffjj
2 G
Actual Set Backs in Feet
North 'South [East (West
CONTR
4' ADD
OR
e'(=:
l ��a 3 9,-e/ CZ'J
DESfGNER
5 ADDRESS
PHONE
53s = 5�fs�4/
Size of Parcel 1 Zone Classification
PHONE
Type Const.
Occupancy
Sprinklered
❑Yes ❑No ❑ Req'd.
Valuation I Building Area in Sq. Ft.
ZIP
Main Floor
Upper Floors
Garage Area
Storage
CHANGE OF USE FROM
6.
TYPE
7. OF
WORK
TO
Area of Decks
Finished Basement
Unfin_ Basement
X NEW
❑ BLD.
❑ ALT. ❑ AD'N.
IL PLMB. 0 MECH.
O RPL.
O M.H.
❑ MVE.
❑ POOL
0 OTHER
No. Baths
No. Stories
No. Rooms
No. of Dwellings
CERTIFICATE
of EXEMPTION
Req'd.
Rec'd.
Not Req'd.
DESCRIBE WORK
8.
VALUATION
9.
SOURCE
OF
UTILITIES
GAS
LECTRIC
//Y , / e 1?LG-zz2%
Enum. Dist.
Location (Area)
WATER
SEWER
Ownership
Public ❑ Private 0
USE CODE
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. SEE REVERSE SIDE FOR REQUIRED INSPECTIONS
DATE OF APPLICATION `2."--/e)
SIGNATURE OF APPLICANT
SPECIAL APPROVALS SPECIAL CONDITIONS:
NAME DATE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
Building Technician
awe
r ra)6
S
1 5/�urC
Wij
t Dw'
p, 5/4Ow£ws
PERMIT IS
1. 4VA 604 z" --
NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
FEES COLLECTED
Single $
Building
Plumbing (}/
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL $
PERMIT NUMBER
F/it-J 7/
03* *61.00
*61.00
*61.006
A *0.00
137.02 .
02-11-81
2 64'79,
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
02:-14x'81 137.1g
DATE ISSUED PERMIT NO.
*QLU0G. 1-
TOTAL
TOTAL