1981, 09-18 Permit: 81A-9564 Mechanical FixturesPLAN NUMBER
APPLICATION/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
1.
2.
3.
JOB ADDRESS
\-\
LO
BLOCK `DIVISION
LEGAL DESCRIPTION — SEE ATTACHED
OWNER
PHONE
PARCEL NUMBER/5
ADDRESS
V(:,51 -'s
CONTRACTOR
- \ �
4. ✓� .� \ \ � (�T‘c\) G�
ADDRESS
5.
Set.<.,NF1.
ZIP
(ACA -� v Cn
Actual Set Backs in Feet
North 'South
East
'West
��2 LoNr �Ttot�l��
F \-4C FaL .
DESIGNER
PHONE
ti5SCi-9Sk 1
Size of Parcel Zone Classification
ZIP
ko
Type Const.
Occupancy Sprinklered
❑Yes ❑No ❑ Req'd.
PHONE
Valuation
Building Area in Sq. Ft.
ADDRESS
ZIP
Main Floor Upper Floors
Garage Area
Storage
CHANGE OF USE FROM
6.
TO
Area of Decks
Finished Basement
Unfin. Basement
TYPE
7. OF
WORK
NEW
❑ BLD.
❑ ALT. ❑ AD'N.
❑ PLMB. j-MECH.
❑ RPL. ❑ MVE.
❑ OTHER
❑ M.H. 0 POOL
No. Baths
No. Stories
No. Rooms
No. of Dwellings
CERTIFICATE
of EXEMPTION
Req'd.
Rec'd.
Not Req'd.
DESCRIBE WORK
VALUATION
9.
3 yi 'i' o K) N
SOURCE
OF
UTILITIES
GAS
:Y,
ELECTRI
� yc
*ATE R
C'r171L1�1 {� C. et
SEWER
Enum. Dist. 'Location (Area)
Ownership
Public 0 Private 0
USE CODE
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
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. S��' !EEE REVERSEC�SIDE FOR REQUIRED INSPECTIONS
\
DATE OF APPLICATION " - Q 1 SIGNATURE OF APPLICANT
SPECIAL APPROVALS
NAME DATE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
Building Technician
SPECIAL CONDITIONS:
PERMIT IS NONTRANSFERABLE
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL $ \r\
71)
PERMIT NUMBER
StA -456A
04* * 1 9.00
* 19.00 N
* 19.008
A *0.00
95638
09-18-81
2 6479,
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
O9-1-&'-81
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE DATE ISSUED
956.45 *19.000J -
PERMIT NO.
TOTAL
›-
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