1980, 06-18 Permit: 80-5963 Plumbing Fixtures!PLAN 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
1. JOB ADXSSills (
LOT SUBDIVISION
2.
BLOCK
LEGAL DESCRIPTION - SEE ATTACHED
3.
OWNER
ADDRESS
4. CONTRA1141u9.0 oewV!
ADDRESS
/3? -1
PHONE
ZI P
PHONE
Z I /,1/1[il e 7
PARCEL NUMBER/S
Actual Set Backs in Feet
North 'South LEast IWest
Size of Parcel I Zone Classification
Type Const.
Occupancy
Sprinklered
❑Yes ❑No ❑ Req'd.
5.
DESIGNER
PHONE
Valuation (Building Area in Sq. Ft.
ADDRESS
ZI P
Main Floor
Upper Floors l Garage Area
Storage
CHANGE OF USE FROM
6.
TO
Area of Decks
Finished Basement
Unfin. Basement
TYPE
7. OF
WORK
,NEW ❑ ALT. ❑ AD'N. ❑ RPL. ❑ MVE.
❑ BLD. . PLMB. ❑ MECH. 0 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.
VALUATION
9.
1
1 Z. "f.'rikrc
Enum. Dist.
Location (Area)
SOURCE
OF
UTILITIES
GAS
ELECTRIC
WATER
SEWER
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 reg lating construction or the
performance of construction. SEE REV RSE SIDE FOR REQUIRED INSPECTI�S (�
DATE OF APPLICATION
SPECIAL APPROVALS
NAME DATE
Env. HeaIP-
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
B 'ng Te h ician
_VVVVrt, \s
SIGNATURE OF APPLICANT
SPECIAL CONDITIONS:
PERMIT IS NONTRANSFERABLE
FEES COLLECTED
Single $
Building
Plumbing
3040
Mech.
Plan Check
SEPA
Mobile Home 1
Other (Specify) 3�V
TOTAL $ 33 OU
PERM.T NUMBER
`6C _tai(03
03* *3300
*3300 105
*33006
B *0.00
5962
06-18-80
2 6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
046,f -1,U g,O
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE DATE ISSUED
596.35 *33,0021:1
PERMIT NO. TOTAL