1980, 11-04 Permit App: 80B-3197 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
6 • C
LOT BLO SUBDIVISION
LEGAL DESCRIPTION — SEE ATTACHED
OWNER
ADDRESS
JQv_
4' ADDRESS
•
DESIGNER
CONTRACTOR
PHONE
9a7-6'404
ZIP
CNQ
PHONE
PARCEL NUMBER/S
Actual Set Backs in Feet
North (South lEast (West
Size of Parcel 1 Zone Classification
5.
ZIP)40
Type Const.
Occupancy
Sprinklered
Yes ❑No ❑ Req'd.
PHONE
Valuation (Building Area in Sq. Ft.
ADDRESS
ZIP
Main Floor
Upper Floors 1 Garage Area
Storage
CHANGE OF USE FROM
6.
TYPE
7, OF
WORK
TO
Area of Decks
Finished Basement
Unfin. Basement
❑ NEW ❑ ALT. C AD'N. ❑ RPL. 0 MVE.
0 OTHER
❑ BLD. 0 PLMB. Eit MECH. ❑ M.H. 0 POOL
DESCRIBE WORK
8. � .144' —I
VALUATION
9.
SOURCE
OF
UTILITIES
GAS
No. Baths
No. Stories
No. Rooms
No. of Dwellings
CERTIFICATE
of EXEMPTION
R
eq'd.
Recd. Not Req'd.
Enum. Dist. I Location (Area)
ELC-C1 RIC
WATER
SEWER
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. SEE REVERSE SIDE FOR REQUIRED INSPECTIIS
DATE OF APPLICATION )0—,-4.1 -Pc)
SIGNATURE OF APPLICANT
SPECIAL APPROVALS SPECIAL CONDITIONS:
NAME DATE
Env. Health
Planning
Fire Marshall
Co. Enginee
Utilities
Plans Examiner
SEPA Checklist
Building TecIhniciann
Oigetwlial
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
FEES COLLECTED
Single $
Building
Plumbing
Mech. 3.36,
D
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL $
M
PERMIT' NUMBER
�0.L3-3/gi7
04* *900
*9.00 l
*9.006
A *0.00
31962
11-04-80
2 6479,
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
3:19,72 *'9002 -
DATE ISSUED PERMIT NO. TOTAL ,
FILE COPY