1980, 06-03 Permit: 80-5277 Plumbing FixturesPLAN 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.
JOB ADDRESS
LOT BLOCK SUBDIVISION
1 GL'f:\
OWNER PHONE
G K
PcIP _ eel lat
ADD ESS
LEGAL DESCRIPTION - SEE ATTACHED
PARCEL NUMBER/S
ZIP
gSOSri
Actual Set Backs in Feet
North (South East 'West
4.
CONTRACTOR
ADDRESS
PHONE
ZIP
Size of Parcel 1 Zone Classification
Type Const.
Occupancy
Sprinklered
Elves ❑No ❑ Req'd.
DESIGNER
5' ADDRESS
PHONE
Valuation 1Building Area in Sq. Ft.
ZIP
Main Floor
Upper Floors 1 Garage Area
Storage
CHANGE OF USE FROM
6.
TYPE
7. OF
WORK
TO
Area of Decks
Finished Basement
Unfin. Basement
NEW 0 ALT. 0 AD'N. 0 RPL. 0 MVE.
0 BLD. PLMB. 0 MECH. 0 M.H. ❑ POOL 0 OTHER
No. Baths
No. Stories
No. Rooms
No. of Dwellings
CERTIFICATE
of EXEMPTION
Req'd.
Rec'd.
Not Req'd.
DESCRIBE WORK
8. cel ( ,ARA, t RX �u-v 5
VALUATION
9.
SOU RCE
OF
UTILITIES
C�.)P>A>Lm
GAS ELECTRIC
WATER
SEWER
Enum. Dist. I Location (Area)
Ownership
Public 0 Private 0
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 construction. SEE REVERSE SIDE FOR REQUIRED INSPECTIONS
DATE OF APPLICATION SIGNATURE OF APPLICANT
SPECIAL APPROVALS
NAME DATE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
ing Te ician
SPECIAL CONDITIONS:
c EA
1-c
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
FEES COLLECTED
Single $
Building
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify) D
oc)
TOTAL $ t1.
PERMIT NUMBER
0 -sarn
03* *800
*800 .i
*8,00
f *0,00 8
527,6A
06-03-80
A 6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
0
DATE ISSUED
52.7.'7
PERMIT NO.
*8.002.
TOTAL