1981, 02-18 Permit: G81A-1594 Gas PipePLAN 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.
4.
JOB ADDRESS`
LOT LO
//i' 1
B CK ISI;JBDIVISION
OWNER
ADDRESS
CONTRACT
ADDft
LEGAL DESCRIPTION - SEE ATTACHED
SOf 72 L -
DESIGNER
5.
ADDRESS
PRONE
ZIP
PARCEL NUMBER/5 •
Actual Set Backs in Feet
North 'South
PHONE, $' of Parcel
DIN5:7.46 11
PHONE
Type Const.
Valuation
Occupancy
East
West
Zone Classification
Sprinklered
❑Yes ❑No ❑ Req'd.
Building Area in Sq. Ft.
ZIP
Main Floor
Upper Floors
Garage Area
Storage
CHANGE OF USE FROM
6.
TO
Area of Decks
Finished Basement
Unfin. Basement
TYPE
7. OF
WORK
NEW ❑ ALT.
❑ BLD. ❑ PLMB.
❑ AD'N. ❑ RPL. 0 MVE.
Cd MECH. 0 M.H. 0 POOL
0 OTHER
No. Baths
No. Stories
No. Rooms
No. of Dwellings
CERTIFICATE
of EXEMPTION
Req'd.
Rec'd.
Not Req'd.
DESCRIBE DFjK
8.
VALUATION
9.
URCE
OF
UTILITIES
GAS
x
ECTRIC
WAR
SEWER
Enum. Dist.
Ownership
Public ❑ Private ❑
Location (Area)
USE CODE
r
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 INSP • IONS
DATE OF APPLICATION- — ��i 1 SIGNATURE OF APPLICA
SPECIAL APPROVALS
NAME DATE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
fcian
SPECIAL CONDITIONS:
1/
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSLJANCF
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
y('
-
TOTAL $
PERMIT NUMBER
A -- I 4
04*
* 1 8,00
* 1a00
159,32
02-18-81
6,479,
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
02-1,&x.81
noTP icci 'Cr,
159.45 *18,00d�
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