1981, 05-04 Permit: 81A-4264 Plumbing 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
JOB ADDRESS
LEGAL DESCRIPTION - SEE ATTACHED
LOT
2
BLOCK
SUBDIVISION
3.
OWNEVI0
ADDRESS
ZI6
PARCEL NUMBER/S
Actual Set Backs in Feet
North (South
East
'West
CONT [TOR
4.
ApR�SS /4:J//LL g
DESIGNNNER
5' ADDRESS
PHONE
Size of Parcel
Zone Classification
ZI9„?//
PHONE
Type Const.
Occupancy
Sprinklered
❑Yes ❑No ❑ Req'd.
Valuation
Building Area in Sq. Ft.
ZI P
Main Floor
Upper Floors 1 Garage Area
Storage
CHANGE OF USE FROM
6.
TO
Area of Decks
Finished Basement
Unfin. Basement
TYPE
7. OF
WORK
EW
❑ BLD.
❑ ALT. ❑ AD'N. ❑ RPL. ❑ MVE.
❑ OTHER
LMB. ❑ MECH. 0 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
8. 14 FtXi
Enum. Dist. I Location (Area)
VALUATION SOURCE GAS
OF
9. UTILITIES
ELECTRIC
WATER
SEWER
Ownership USE CODE
Public ❑ Private ❑
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. SEE REVERSE SIDE FOR REQUIRED INSPECT a NSA ,nit
DATE OF APPLICATION U , SIGNATURE OF APPLICAN
SPECIAL APPROVALS
NAME DATE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
SPECIALC�TIONS:
deee--42-
7;
7I
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
FEES COLLECTED
Single $
Building
Plumbing C! [ j
'
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL
PERMIT NUMBER
8l - azo
03* *61.00
*61.00 U)
*61,006
A *0.00
42632
05-04-81
z 6.[.79.
,r.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
05; 0� 81 426.42 *6].00a0--
DATE ISSUED
PERMIT NO. TOTAL