1980, 04-28 Permit: 80-4003 Plumbing Fixturesr7=APPLICATION/PERMIT
PERMIT NUMBER
SPOKANE COUNTY — BUILDING CODES DEPARTMENT
W L100S
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
DATE
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 4 COPIES
o
03* *3&00
JOB ADDRESS
1. !
LEGAL DESCRIPTION — SEE ATTACHED
*3R00 ro
LOT BLOCK ISUBDIVISIONPARCEL
NUMBER/S
2•
*3a0061
OWNER PHONE
E *000 VO
3.
400.22
ADDRESS
ZIP
Required Set Backs in Feet
CONTR TOR
PHON
North South East West
Size of Parcel Zone Classification
0 (� 2 $ — 0
4'
—
64179.
'
A RE55 •
ZIP f�
Type Const. Occupancy Sprinklered
�}�J
-
❑Yes ❑No ❑ Req'd.
D
5.1
PH N �
,4
Valuation Building Area in Sq. Ft.
'
—
�x
ZI
/
DWL Area
Basement Area
Garage ArV,37LOSS
CHANGE OF USE FROM
TO
Split Entry
Split Level
Rancher
6.
TYPE
X -NEW ElALT. ❑ AD'N. ❑ RPL. ❑ MVE.
No. Baths No. Floors No. Rooms Rec. Room
7, OF ❑ OTHER
WORK ❑ BLD. WIPLMB. ❑ MECH: ❑ M.H. ❑ POOL
CERTIFICATE Req'd. Recd. Not Req'd.
of EXEMPTION
DESCRIBE WORK
8. � X FEESCOLLECTED
VALUATION
Source
GASELECTRIC
WATER
SEWER
9.
of
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.e g nting of a permit does not presume
to give authority to violate or cancel the provisions of any other state or I al law r a ing c truction or the �
perform e f const
ction. Plumbing J�g�.L
DATE SIGNATURE if
Mech.
SPECIAL APPROVALS SPECIA C NDITIONS:
DEPT. REQ'D. REC'D. Plan Check
Env. Health
Planning SEPA
F—
U
Fire Marshall Mobile Home
— W
o-
Co. Engineer
W
Other (Specify)
Utilities
TOTAL $
Zone Clearance
WHEN MACHINE VALIDATED
SEPA Checklist
IN THIS SPACE,
YES THIS BECOMES A PERMIT.
P. 3 %i DATE'g�FFICIA11
4 0 0,3 6 *3 8.0 0 0
APPROVED FOR ISSUANCE