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1981, 05-15 Permit: 81A-4774 Plumbing Fixtures
J.< PLAN NUMBER APPLICATION/PERMIT f PERMIT NUMBER - SPOKANE COUNTY - BUILDING CODES DEPARTMENT Sin -.-174 eil NORTH 811 JEFFERSON / SPOKANE,WASHINGTON 99260 / (509) 456-3675 DATE APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 4 COPIES JOB ADDRESS1. .f/ LEGAL DESCRIPTION — SEE ATTACHED 0 3 * * 6 1, 0 C LOT BLOCK SUBDIVISION PARCEL NUMBER/S i 6- 2. * v 1.0 0 OWNER PHONE 34 t'p5 i c iJ rd t--,44/-1 /r,' 3'x)1- G vie ! t * (' ADDRESSRequired Set Backs in Feet S / 33C =A4e.ix1 Zj/GS442I 1 I 477 ,' _" North South East West CONTRACTOR PHONE Size of Parcel Zone Classification Sy 0 + 5- 1 j.t L1 ILvi-. 6 Nj b,)d SO 4. ADDRESS ZIP Type Const. Occupancy Sprinklered F. /1 7 C it f Sr/cvai,s yY,24 // ❑Yes ❑No ❑ Req'd. DESIGNER PHONE Valuation Building Area in Sq. Ft. 5. ADDRESS ZIP DWL Area Basement Area Garage Area Storage — CHANGE OF USE FROM TO Split Entry Split Level Rancher 6. No.Baths No. Floors No. Rooms Rec. Room TYPE ❑ NEW ❑ ALT. ❑ AD'N. ❑ RPL. 0 MVE. 7. OF ❑ OTHER - CERTIFICATE Req'd. Recd. Not Req'd. WORK ❑ BLD. 0 PLMB. ❑ MECH: ❑ M.H. ❑ POOL of EXEMPTION DESCRIBE WORK FEES COLLECTED 8. W. /111;,'"74 /,i /=. Kf✓,cPl VALUATION Source GAS ELECTRIC WATER SEWER of 9. Utilities Single $ 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 Building type of work will be complied with whether specified herein or not. The granting of a permit does not presume togive authorityto violate or cancel the provisions of any other state or local law regulating construction or the �, Plumbing �,, O performance of construction. 1 ii— DATE C" /f1' YI SIGNATURES"' a..041 Mech. SPECIAL APPROVALS SPECIAL CONDITIONS: DEPT. REQ'D. REC'D. J Plan Check /! f ,)1/' r;.1 r. $ Env.Health c SEPA O I— U W Planning _ Cl. Mobile Home rn Fire Marshall ——' Co. Engineer Other (Specify) Utilities TOTAL $ I k ©� Zone Clearance WHEN MACHINE VALIDATED IN THIS SPACE, SEPA Checklist ` THIS BECOM€S A.P,ERMIT. r DATE A OFFICIAL �/ /..... C- 0 1� I1 5-B 1: 4 7 7 4 Z *610 O a. APPROVED FOR SSUA CE