1981, 05-21 Permit: 81A-5000 Plumbing FixturesAPPLICATION/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
JOB ADDRESS
k4 -z5 cH
LOT Eft OCK SUBDIVISION
LEGAL DESCRIPTION — SEE ATTACHED
PARCEL NUMBER/S
OWNER
3. —)GE Mt�kiil.i t
ADDRESS
CONTRACTOR
4
A.t1R>
PHONE
ZIP
PHONE
Actual Set Backs in Feet
North 'South
East
West
Zone of Parcel Classification
' ADDRESS
ZIP
Type Const.
Occupancy
DESIGNER
5.
ADDRESS
6.
PHONE
Sprinklered
❑Yes ❑No ❑ Req'd.
Building lding Area in Sq. Ft.
CHANGE OF USE FROM
ZIP
Main Floor
Garage Floors Area
Storage
TO
Area of Decks
Finished Basement
Un in. Basement
TYPE
7. OF
WORK
2 NEW 0ALT. ❑ AD'N. 0 RPL. ❑ MVE.
0 BLD. W PLMB. 0 MECH. 0 M.H. ❑ POOL
DESCRIBE WORK
8. Fticrctee"`}
0 OTHER
No. Baths
No. Stories
No. Rooms
No. of Dwellings
CERTIFICATE
of EXEMPTION
Req'd.
Rec'd
Not Req'd.
Enum. Dist.
Location (Area)
9.
VALUATION SOURCE
OF
UTILITIES
GAS
ELECTRIC
WATER
SEWER
Ownership
Public 0 Private 0
USE CODE
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
type of work will be complied with whether specified herein or not. The grantinga permit does not presume
to give authority to violate or cancel the provisions of any other state or local w reg lating construction or the
performance of construction. SEE REVERSE SIDE FOR REQUIRED INSPEC IONS
DATE OF APPLICATION SIGNATURE OF APPLICANT
SPECIAL APPROVALS
NAME DATE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
Buj.l.qing Technician
SPECIAL CONDITIONS:
3
L,Fkv
1 `Cu.i3
•1 .3 Ston, 6 C
A kTCk Et.
14Z o wax-
i SC+L:,Z P1 i%t.=
14
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
FEES COLLECTED
Single $
Building
Plumbingd
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL $ `J.Ci�•
!PERMIT NUMBER
03* *60.00
*6000 ro
*60006
A *000
499.9
05-21-81
6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
015-21x.81 500,0Z *6 0,0
DATE ISSUED PERMIT NO. TOTAL