1982, 03-22 Permit: 82A-2058 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
JOB ADDRESS
192/7- #4-.
LOT
2.
BLOCK
SUBDIVISION
LEGAL DESCRIPTION — SEE ATTACHED
PARCEL NUMBER/S
OWNER
ADDRESS
PHONE
ZIP
CON RACTOR f
Az: elebdiC
4.
ADDREs.
DESIGNER
5.
ADDRESS
PHONE
V
Z0'4/6
Actual Set Backs in Feet
North 'South
Size of Parcel
East
'West
Zone Classification
Type Const.
Occupancy
Sprinklered
Oyes ❑No ❑ Req'd.
PHONE
Valuation
Building 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
❑ NEW
❑ BLD.
❑ ALT.
❑ PLMB.
❑ AD'N.
❑ MECH.
❑ RPL. ❑ MVE.
0 OTHER
❑ M.H. El POOL
No. Baths
No. Stories
No. Rooms
No. of Dwellings
CERTIFICATE
of EXEMPTION
Req'd.
Rec'd.
Not Req'd.
DESCRIBE WORK
8.
J " ri)t rv'Ci
Enum. Dist. I Location (Area)
VALUATION
9.
SOURCE GAS
OF
UTILITIES
ELECTRIC
WATER
SEWER
Ownership
Public 0 Private 0
USE CODE
1 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 regulatin o ruction or the
performance of construction. SEE REVERSE SIDE FOR REQUIRED INSPECTIONS
DATE OF APPLICATION 3 ,.
SPECIAL APPROVALS
NAME DATE
Env. Health
Planning
0
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
Building
e
SIGNATURE OF APPLICANT
SPECIAL CONDITIONS:
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 $!4eC1
PERMIT NUMBER
8211 2e58
3.22 'gt.,'
bi .0
CA4L
KueP+ it 5-1
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATEISSUED
s
PERMIT N .
*49.00
O J
TOTAL