1980, 07-15 Permit: 80-7094 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
1.
2.
3.
JOB ADDRE(SSS, • "��j "y{
LOT BLOCK• SUB ION (C:Krti (ssao
LEGAL DESCRIPTION - SEE ATTACHED
OWNElizylza
ADDRESS
PHONE
ZI P
PARCEL NUMBER/S
Actual Set Backs in Feet
North !South
East
'West
4.
CONTRACTOR
ADDRESS
(0, S q.(v E
•
DESIGNER
5. ADDRESS
PHONE
5'Fp»733`3
ZIP
CiC+A.1
PHONE
Size of Parcel 1 Zone Classification
Type Const.
Occupancy
Sprinklered
❑Yes ❑No ❑ Req'd.
Valuation 1Building Area in Sq. Ft.
ZIP
Main Floor
Upper Floors 1 Garage Area
Storage
CHANGE OF USE FROM
6.
TO
Area of Decks
Finished Basement
Unfin. Basement
TYPE
7. OF
WORK
I NEW
❑ BLD.
❑ ALT. D AD'N.
❑ PLMB. JR,1 MECH.
❑ RPL.
❑ M.H.
❑ MVE.
❑ POOL
❑ OTHER
No. Baths
No. Stories
No. Rooms
No. of Dwellings
CERTIFICATE
of EXEMPTION
Req'd.
Recd.
Not Req'd.
DESCRIBE WORK
8- �Y\--t AAIT.c, Ve �..gl
. S1VMi n
VALUATION SOURCE GAS ELECTRIC WATER SEWER
OF
9. UTILITIES
Enum. Dist. I Location (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 APPLICANT
SPECIAL APPROVALS
NAME DATE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
SPECIAL CONDITIONS:
R PE,o of; i
3Ic7F Ita"
PERMIT IS NONTRANSFERABLE
FEES COLLECTED
Single $
Building
Plumbing
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL
$ �y
PpZRMIT NUMBER
04* *4.00
* 14.00 rn
* 14.006
E *0,00
709,38
07-15-80
g 6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
071-1,5'-8+0
709.42
*14,00° -
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE DATE ISSUED PERMIT NO. TOTAL