1980, 04-22 Permit: 80-3783 Mechanical FixturesPLAN NUi•®J3ER APPLICATION/ PERMIT PERMIT NUMBER
SPOKANE COUNTY — BUILDING CODES DEPARTMENT *— 1
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675 DATE
DESCRIBE WORK
s. j � i ALL
FEES COLLECTED
VALUATION
9,
Source
of
Utilities
APPLICANT:
COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 4 COPIES
WATER
JOB ADDRESS
.„rte
1 hereby certify that I have read and examined this application and have read the "NOTICE" provisions included
LEGAL DESCRIPTION — SEE ATTACHED
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
LOT
BLOCK
SUB IVISION
PARCEL NUMBER/S
2.
SPECIAL APPROVALS SPECIAL CONDITIONS:
DEPT. REQ'D. RECD.
Plan Check
Env. Health
OWNER
SEPA
Planning
PHONE
Mobile Home
Fire Marshall
Co. Engineer
Utltes
—9
�of
3
ADD ESS
IP
Required Set Backs in Feet
P
/
Q!/
North South
East West
CONTRACTOR
PHONE
Size of Parcel
Zone Classification
E
1
_q,!
4.
ADDRESS
tip
Type Const.
Occupancy
Sprinklered
❑Yes ❑No ❑ Req'd.
DESIGNER
PHONE
Valuation
Building Area in Sq. Ft.
5.
ADDRESS
ZIP
DWL Area
Basement Area
Garage Area
Storage
CHANGE OF USE
FROM
TO
Split Entry
Split Level
Rancher
6.
No. Baths
No. Floors
No. Rooms
Rec. Room
TYPE NEW
El ALT.
❑ AD'N. ❑ RPL. ❑ MVE.
7,
OF
1:1 BLD.
❑ PLMB.
[E] OTHER
*MECH: [IM.H. ❑ POOL
CERTIFICATE
Req'd.
Recd.
Not Req'd.
WORK
of EXEMPTION
DESCRIBE WORK
s. j � i ALL
FEES COLLECTED
VALUATION
9,
Source
of
Utilities
GAS
ELECTRIC
WATER
SEWER
Single $
1 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
Plumbing
performance of construction.
DATE SIGNATURE
Mech.
SPECIAL APPROVALS SPECIAL CONDITIONS:
DEPT. REQ'D. RECD.
Plan Check
Env. Health
SEPA
Planning
Mobile Home
Fire Marshall
Co. Engineer
Utltes
Other (Specify)
•DDZoTOTA L $ —7,00--
Zone
ne Clearance
WHEN MACHINE VALIDA7
SEPA Checklist q0jyVVUCw\
THISC,'4"-
BECO 1MES A,CPE((�1RMIT.
DATE�FFICIAL l; .4 L 2,. U 0
APPROVED FOR ISSUANCE
04* *7.00
*7,00 N
*7,006
E *0.00 00
378; 2:9
04=22-80
6,479.
1
a
i SPACE,
? ,3' *7,00GF=