1980, 03-10 Permit: 80-1946 Plumbing FixturesPLAN NUN.3ER
APPLICATION/ PERMIT
SPOKANE COUNTY — BUILDING CODES DEPARTMENT
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 4 COPIES
JOB ADDRESS
LEGAL DESCRIPTION — SEE ATTACHED
LOT I BLOCK SUBDIVISION PARCEL NUMBER/S
PERMIT ,NUMBF-R
DATE
X30- ya
VALUATION Source 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
performance of construction. Plumbing
30
DATE :3—/y <:-J SIGNATURE _-- � f'T"
Mech.
SPECIAL APPROVALS SPECIAL CONDITIONS:
DEPT. REQ'D. RECD. Plan Check
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Zone Clearance
SEPA Checklist
P
DAT' � FICIAL
// P OR ISSUANCE
SEPA
Mobile Home
Other (Specify)
TOTAL $
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
o
3--1a
OWNER
/PHONE
�4✓� �vr'riV
�0zV-1
3.
u�lr�tll' / i`�3iv
I�D
ADDRESS
ZIP
Required Set Backs in Feet
// .�/'
'1G � �
�P /
o` 7'
North South
East West
CFNTRACTOR
PHONE
Size of Parcel
Zone Classification
4'
ADDRESS
//
ZIP
Type Const.
I 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.
TYPE VNEW El ALT.
ElAD'N. El RPL.
1:1MVE.
No. Baths
No. Floors
No. Rooms
Rec. Room
7,
OF
WORK BLD. XPLMB.
❑ MECH: ElM.H.
El OTHER
El POOL
CERTIFICATE
Req'd.
Recd.
Not Req'd.
of EXEMPTION
DESCRIBE WORK
s.
PL0H ex,,
FEES COLLECTED
PERMIT ,NUMBF-R
DATE
X30- ya
VALUATION Source 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
performance of construction. Plumbing
30
DATE :3—/y <:-J SIGNATURE _-- � f'T"
Mech.
SPECIAL APPROVALS SPECIAL CONDITIONS:
DEPT. REQ'D. RECD. Plan Check
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Zone Clearance
SEPA Checklist
P
DAT' � FICIAL
// P OR ISSUANCE
SEPA
Mobile Home
Other (Specify)
TOTAL $
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
o
3--1a