1981, 03-10 Permit: M81A-2222 Mechanical Fixtures!PLAN NUMBER
APPLICATION/PERMIT
SPOKANE COUNTY - BUILDING CODES DEPARTMENT
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
2.
3.
APPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 3 COPIES
JOB ADDRESS
LOT
1/5 ( .
BLOCK
OWNERtf
ADDRESS
SUBDIVISION
LEGAL DESCRIPTION - SEE ATTACHED
4.
CONTf{gCTOR
ADDRMSS
DESIGNER
5.
ADDRESS
7,/._ t -,s1C e=t
PHONE
ZI P
PHONE
z S:
PARCEL NUMBER/S
Actual Set Backs in Feet
North (South
Size of Parcel
Type Const.
East
Occupancy
'West
Zone Classification
Sprinklered
❑Yes ❑No ❑ Req'd.
PHONE
Valuation
Building Area in Sq. Ft.
ZIP
Main Floor
Upper Floors I1 Garage Area
Storage
CHANGE OF USE FROM
6.
TO
Area of Decks
Finished Basement
Unfin. Basement
TYPE
7. OF
WORK
NEW 0 ALT.
❑ PLMB.
❑ BLD.
DESCRIBE WORK\
8. •� , S�
VALUATION
9.
SOURCE
OF
UTILITIES
0 AD'N. ❑ RPL. ❑ MVE.
„0-MECH. 0 M.H. 0 POOL
❑ OTHER
WATER
SEWER
No. Baths
No. Stories
No. Rooms
No. of Dwellings
CERTIFICATE
of EXEMPTION
Enum. Dist.
Ownership
Public ❑ Private ❑
Location (Area)
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 constru . SEE REVERSE SIDE FOR REQUIRED INSPECTIONS
DATE OF APPLICATION
SIGNATURE OF APPLICANT
SPECIAL APPROVA SPECIAL CONDITIONS:
NAME DATE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
Req'd.
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
Rec'd.
Not Req'd.
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL
$
h�
PERMIT NUMBER
04* *14.00
*14.00
*14.006
A *000
22212
03-10-31
g 6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
031-1.,0_81'
DATE ISSUED
22222
PERMIT NO
*1400°
rn r