1981, 09-14 Permit: P81A-9270 Plumbing Fixtures(PLAN NUMBER
1
r
2.
APPLICATION/PERMIT
SPOKANE COUNTY — BUILDING CODES DEPARTMENT
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
JOB ADDRESS
LOT
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
L. 1),.' iC(
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BLOCK SUBDIVISION
LEGAL DESCRIPTION — SEE ATTACHED
OWNER
3 C=1rAc n
ADDRESS
E✓.12.cAiGc
CONTRACTOR
4. AVINL
ADDRESS
SA -VY.
DESIGNER
5.
6.
ADDRESS
Lx.), 1Mitcr s.
JC.YVI�I'�
PHONE
—44.6
ZIP
PARCEL NUMBER/S
PHONE
Actual Set Backs in Feet
North 'South
Size of Parcel
East 'West
Zone Classification
ZI P
Type Const.
Occupancy
PHONE
Valuation
Sprinklered
❑Yes ❑No ❑ Req'd.
Building Area in Sq. Ft.
CHANGE OF USE FROM
ZIP
Main Floor
Upper Floors
Garage Area
Storage
TO
Area of Decks
Finished Basement
Unfin. Basement
TYPE
7. OF
WORK
O NEW
❑ BLD.
❑ ALT.
PLMB.
DESCRIBE WORK
8. i &-cLkQErs
VALUATION
9.
SOURCE
OF
UTILITIES,
❑ AD'N.
❑ MECH.
❑ RPL.
❑ M.H.
❑ MVE.
❑ POOL
❑ OTHER
No. Baths
No. Stories
No. Rooms
No. of Dwellings
CERTIFICATE
of EXEMPTION
Req'd.
Rec'd.
Not Req'd.
Enum. Dist. I Location (Area)
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 regulating construction or the
performance of construction. SEE REVERSE SIDE FOR REQUIRED INSPECTIONS
WDATE OF APPLICATIO
SPECIAL APPROVALS
NAME DATE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
Building Technician
SIGNATURE OF APPLICANT
SPECIAL CONDITIONS:
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
FEES COLLECTED
Single $
Building
Plumbing ?-Az
—.Cx')
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL
PERMIT NUMBER
tv41/4 'Xi
03* *2500
*2500
*25.006
A *000
9269-6
09-14-81
2 d79,
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2
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WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
09_►141`_81
DA F I' RI IF fl
927, Oz
DCDR/IIT rIII
*25,00
as