1980, 01-31 Permit: 80-792 Plumbing FixturesPLAN NUMBER
APPLICATION/ PERMIT
SPOKANE COUNTY — BUILDING CODES DEPARTMENT
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
TYPE LJ-flEW ❑ ALT. ❑ AD'N. ❑ RPL. ❑ MVE.
7, OF�j� ❑ OTHER
WORK
El BLD. 4� PLMB. ❑ MECH: ElM.H. 1-1POOL CERTIFICATE Req'd. I Rec'd. Not Req'd.
of EXEMPTION
8. DESCRIBE WORK 41
FEES COLLECTED
VALUATION11 urce 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
to give authority to violate or cancel the provisions of any other state or local law regulating construction or the
performances of construction. Plumbing
DATE % /.a%/ff SIGNATURE ,t;,��� Mech.
SPECIAL APPROVALS
DEPT. REQ -D. RECD.
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Zone Clearance
SEPA Checklist
SPECIAL CONDITIONS:
APPLICANT:
COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 4 COPIES
JOB ADDRESS
LEGAL DESCRIPTION — SEE ATTACHED
Mobile Home
if
LOT
BLOCK
SUBDIVISION
$�'
PARCEL NUMBER/S
2.
i (AJ
I
�— THIS BECOMES A PERMIT.
DATE OFFICIAL P/)AV— 44i21/!it/�i
L,—
APPROVED FOR ISSUANCE
OWNER
PHONE
3.
AI5[:5RES9
ZIP
Required Set Backs in Feet
North South
East West
CON ACTOR
PHONE
Size of Parcel
Zone Classification
4.
ADDRESS
ZIPp
Type Const.
Occupancy
Sprinklered
�%T
❑Yes ❑No ❑ Req'd.
�•.
DESIGNER
PHONE
Valuation
Building Area in Sq. Ft.
5'
ADDRESS
ZIP
DWL Area
Basement Area
Garage Ar;WT
Storage
CHANGE OF USE FROM
TO
Split Entry
Split Level
Rancher
6.
No. Baths
No. Floors
No. Rooms
Rec. Room
TYPE LJ-flEW ❑ ALT. ❑ AD'N. ❑ RPL. ❑ MVE.
7, OF�j� ❑ OTHER
WORK
El BLD. 4� PLMB. ❑ MECH: ElM.H. 1-1POOL CERTIFICATE Req'd. I Rec'd. Not Req'd.
of EXEMPTION
8. DESCRIBE WORK 41
FEES COLLECTED
VALUATION11 urce 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
to give authority to violate or cancel the provisions of any other state or local law regulating construction or the
performances of construction. Plumbing
DATE % /.a%/ff SIGNATURE ,t;,��� Mech.
SPECIAL APPROVALS
DEPT. REQ -D. RECD.
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Zone Clearance
SEPA Checklist
SPECIAL CONDITIONS:
Plan Check
SEPA
Mobile Home
if
Other (Specrf )
c I L(•�
$�'
TOTAL
i (AJ
WHEN MACHINE VALIDAT
�— THIS BECOMES A PERMIT.
DATE OFFICIAL P/)AV— 44i21/!it/�i
L,—
APPROVED FOR ISSUANCE
PERMIT NUMBER
SS4— 79-Z
DATE
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C11-31
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