1981, 12-28 Permit: 81B-3002 Mechanical FixturesPLAN NUMBER
APPLICATION/PERMIT
SPOKANE COUNTY — BUaLDIMG 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 ADDRESS
LEGAL DESCRIPTION - SEE ATTACHED
LOT
BLOCK
SUBDIVISION
OWNER
ADDRESS
ion+c:
CONTRACTOR
4. AIY\E
ADDRESS
Sa.PIA
E
DESIGNER
5.
aCjCJrVt:.cZ
PHONE
a7.A.
PARCEL NUMBER/S
ZIP
�
"Z .)
Actual Set Backs in Feet
North (South )East (West
PHONE
Size of Parcel 1 Zone Classification
ZIP
Type Const.
Occupancy
Sprinklered
❑Yes ❑No ❑ Req'd.
PHONE
Valuation (Building Area in Sq. Ft.
ADDRESS
ZIP
Main Floor
Upper Floors 1 Garage Area
Storage
CHANGE OF USE FROM
6.
TYPE
7. OF
WORK
TO
Area of Decks
Finished Basement
Unfin. Basement
(J NEW ❑ ALT. ❑ AD'N. ❑ RPL. 0 MVE.
0 BLD. ❑ PLMB. I'MECH. ❑ M.H. ❑ POOL
0 OTHER
No. Baths
No. Stories
No. Rooms
No. of Dwellings
CERTIFICATE
of EXEMPTION
Req'd.
Rec'd.
Not Req'd.
/DESCRIBE WORK
8.0 1.}5.; .(
VALUATION
9.
SOURC
OF
UTILITIES
GAS cam N� Ei� L�FiT�tirn?
E ELECTRIC
GAS
WATER
Enum. Dist. I Location (Area)
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
DATE OF APPLICATION / 2 — a2Ce3 SIGNATURE OF APPLICANT
SPECIAL APPROVALS
NAME DATE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
Building Technician
SPECIAL CONDITIONS:
'` Ui H z c: t -T
FSO , OCx7 T'u t-utz.")A
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
FEES COLLECTED
Single $
Building
Plumbing
Mech. • inC'
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL
PERMIT NUMBER
gt� CDC:) -Z_
04* *2800
*2800
*28008
A *000
300.1
12-28-81
6479
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
l2'`-:2&-81+ 300.22 *28.00CL E-
0
DATE ISSUED PERMIT NO. TOTAL