1981, 02-18 Permit: 81A-1622 Mechanical 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
1. a. A L.s� J F
LOT, BLOCK SUBDIVISION
2.
3
LEGAL DESCRIPTION — SEE ATTACHED
OW ER 1
' S� QS& (. r SY�V �'v c {
PHONE
PARCEL NUMBER/S
ADDRESS
,a ' Sic. .
ZIP
`‘C Cr,
Actual Set Backs in Feet
North 'South
East
'West
CONTRACTOR
4. A- k [ C c ti,Q
ADDRESS
PHONE
Size of Parcel
Zone Classification
5.
DESIGNER
ZIP
c(c aC,�f
PHONE
Type Const.
Occupancy
Sprinklered
EYes ❑No ❑ Req'd.
Valuation
Building Area in Sq. Ft.
ADDRESS
ZIP
Main Floor
Upper Floors I Garage Area
Storage
CHANGE OF USE FROM
6.
TO
Area of Decks
Finished Basement
Unfin- Basement
TYPE..„...12W7, OF
WORK ❑ BLD.
❑ ALT.�❑AD'N. ❑ RPL. ❑ MVE.
❑ PLMB.//��ECH. ❑ M.H. 0 POOL
❑ OTHER
No. Baths
No. Stories
No. Rooms
No. of Dwellings
CERTIFICATE
of EXEMPTION
Req'd.
Rec'd.
Not Req'd.
DESCRIBE WORK
8. ,Psm
9.
VALUATION
UTILITIESSO CE GAS
OF
- C -T k.;1)0 f TNENN Li_h
L
CT RIC SEWER
e ✓
WATER
Enum. Dist.
ILocation (Area)
Ownership
Public ❑ Private ❑
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
SIGNATURE OF APPLICAN
SPECIAL APPROVALS
NAME DATE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
Building T chnician
SPECIAL CONDITIONS:
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL
f1
PERMIT NUMBER
04* * 1 9.00
*19.00
*19.006
A *0,00 8
1 6 2, 1 2
02-18-8,1
2 6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
0'2i —18't8 1
DATE ISSUED
16 22g
PERMIT NO.
*19.002J-
TOTAL