1981, 05-15 Permit: 81A-4772 Plumbing Fixtures 4
ill-AN NUMBER APPLICATION/PERMIT
PERMIT NUMBER
e SPOKANE COUNTY — BUILDING CODES DEPARTMENT
SUN ----4V-OZ
VNORTH 811 JEFFERSON / SPOKANE,WASHINGTON 99260 / (509) 456-3675 DATE
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 4 COPIES
JOB r ADDRESS S` 4 LEGAL DESCRIPTION — SEE ATTACHED ; 3 *
1. LOT f7'4'ji BLOCK SUBDIVISION PARCEL NUMBER/S * 6 1.0 0
17)
2. �1
OWNER 7 0
PHONE * 6 1. 0 e)
3. A Fti 4 n ,c4,1 ;aa,., ir47 S l Si-Gc9 A * C7
0.0 0
ADDRESS ZIP Required Set Backs in Feet U
S /3 10 /'/'A,r ft I 7P L North 1SouthEast West 4 7 7. 1 2
CONTRACTOR PHONE Size of Parcel Zone Classification
4. �`•i'L /1/..,.,1I Nt ;$' ,- /yc' 05- 1 5-8.1
ADDRESS ZIP �/ Type Const. Occupancy Sprinklered 2 6 4 7 9.
14 / ) f 171,v1�� 5%y.2 / Oyes ❑No ❑ Req'd.
DESIGNER PHONE Valuation Building Area in Sq. Ft.
5. ADDRESS ZIP DWL Area I Basement Area Garage Area I Storage —
CHANGE OF USE FROM TO Split Entry Split Level Rancher
6.
No. Baths No. Floors No. Rooms Rec. Room
TYPE R"NEW ❑ ALT. ❑ AD'N. ❑ RPL. ❑ MVE.
7. OFr� ❑ OTHER
WORK ❑ BLD. Iy/PLMB. I=1 MECH: ❑ M.H. ❑ POOL CERTIFICATE Req'd. Rec'd. Not Req'd.
of EXEMPTION
DESCRIBE WORK
8. Trr
$ yS ,-'f / 9 /'; v .1,,,Ift. r FEES COLLECTED
VALUATION Source GAS ELECTRIC WATER SEWER l
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
to give authority to violate or cancel the provisions of any other state or local law regulating construction or the
performance of construction. '1 Plumbing 6��•Oa)
DATE .S ' 11-- kl SIGNATURE ,s-e.��`" x._il� f
Mech.
SPECIAL APPROVALS SPECIAL CONDITIONS:
DEPT. REQ'D. RECD. `f y .,, ,t' j Plan Check
Env. Health 1T !'f ,
Cr
SEPA O
I—
Planning V
L!
Fa-
Mobile Home co
Fire Marshall
Z
Co. Engineer Other (Specify)
Utilities
TOTAL $ (-)tCr)
Zone Clearance
WHEN MACHINE VALIDATED IN THIS SPACE,
SEPA Checklist ``/�j 7� 9,,,,-.) THIS(�g {7— AQpF�RMIT. /� t']•i'7,
DATE S /J e/OFFICIAL C- ,U 1.e U � 4 / /,2 Z *6 1 0 0 d H
APPROVED F:' I ANCE