1980, 07-23 Permit: M80-7525 Mechanical FixturesPLAN NUMBER
APPLICATION/PERMIT
SPOKANE COUNTY — BUILDING CODES DEPARTMENT
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / 1509) 4563675
APPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 4 COPIES
1.
2.
3.
JOB ADDRESS
t5' 7 1 c . ���:
LUi 8 ULK SUBDIVISI
LEGAL DESCRIPTION - SEE ATTACHED
PARCEL NUMBER/$
OWNER
14--i i -k , > E. S i Tt 0 A.t c.s
ADDRESS
75 ).D t`. • :3 c"E2L.j/
CONTRACTOR
4. ADDRESS
o ^� t F
DESIGNER
5.
PHONE
ZIP
PHONE
ills Ica
Required Set Backs in Feet
North 'South East (West
Size of Parcel 1 Zone Classification
ZIP
Ty Pe Const.
Occupancy
Sprinklered
❑Yes ❑No 0 Req'd.
PHONE
Valuation (Building Area In 5q. Ft.
ADDRESS
CHANGE OF USE FROM
6.
TYPE
7. OF
WORK
ZIP
DWL Area 'Basement Area r Garage Area
Storage
TO
Spilt Entry
Split Level
Rancner
NEW 0 ALT. 0 AD N. 0 RPL. 0 MVE.
0 BLD. ❑ PLMB. RMECH. ❑ M.H. 0 POOL
DESCRIBE WORK
8. a.S KLU IU"tf4A
VALUATION
9.
Source
of
Utilities
GAS
0 OTHER
ELECTRIC
Xk
No. Baths
No. Floors
No. Rooms
Rec. Room
WATER
CERTIFICATE
of EXEMPTION
SEWER
R eq'd.
I hereby certify that I have read and examined this applica ion 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. ,1l�fj
DATE / ^ I Sl - SIGNATURE ( )9.ltiL .IL ll l
SPECIAL APPROVALS
DEPT. REQ•D. RECO.
Env. Health
Planning
Fire Marshall
CO. Engineer
Utilities
Zone Clearance
SEPA Checklist
SPECIAL CONDITIONS:
DATE 7 y Z OF
APPROVED FOR ISSUANCE
Recd. Not Req'd.
FEES COLLECTED
S ogle $
Building
Plumbing
�i
r
Mech. s
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL $
I / PERMIT( t `M75 5 l
DATE •�- I S ' SZ�
724°
7n^
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
% 2 i
CC
0
0
0
W
N