1981, 02-02 Permit: 81A-1091 Plumbing 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
1.
2.
3
JOB A9DRESS
A.5i
LOT
BLOCK
Agf
SUBDIVISION
o
ri E R Dw
.GIjU�_ N` 0, al
ADDRESS
fast SEI 1-4
C
�imE ILum(Elrlc,
4' A DRESS
LEGAL DESCRIPTION — SEE ATTACHED
PARCEL NUMBER/S
ZI P
Actual Set Backs in Feet
North (South [East (West
PHONE
Size of Parcel Zone Classification
ZIP
DESIGNER
PHONE
Type Const.
Occupancy
Sprinklered
Eves ❑No ❑ Req'd_
Valuation Building Area in Sq. Ft.
5' ADDRESS
ZIP
Main Floor
Upper Floors • Garage Area
CHANGE OF USE FROM
6.
TYPE
7. OF
WORK
TO
Area of Decks
Finished Basement
Storage
Unfin. Basement
8/NEW ❑ ALT. ❑ AD'N. ❑ RPL. ❑ MVE.
0 BLD. 1;4FLMB. 0 MECH. 0 M.H. 0 POOL
0 OTHER
No. Baths
No. Stories
No. Rooms
No. of Dwellings
CERTIFICATE
of EXEMPTION
DESCRIBE WORK
8.
9.
VALUATION
SOURCE
OF
UTILITIES
GAS
ELECTRIC
WATE R
Enum. Dist.
ILocation (Area)
Req'd.
Recd.
Not Req'd.
SEWER
Ownership
Public O Private O
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 �u g/
SPECIAL APPROVALS
NAME DATE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
SIGNATURE OF APPLICANT
SPECIAL CONDITIONS:
c PeC00n-\ 1 Co nm
Li) A-iclUsc f 7.00
d<•r 1 5 nk
I- Skc,c, �qsz
FE
400
500
/700
000cr!oOeinen`r
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 $
PERMIT NUMBER
03* *17.00
*17.00
*17.006
A *0.00
109.02
02-02-8J
2 6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
02it0.2
109.11
*1`7.00Ze
DATE ISSUED - PERMIT NO. TOTAL