1981, 06-24 Permit 81A-6268 Gas PipingPLAN 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
LOT
1,. 126312 CA) to
BLOCK SUBDIVISION
hy.-10/\:t5 I f�FdLE
3.
4.
OWNER
OD1? f \)'AA tt_I.ff.lr
PHONE
q Z- 1151
ADDRESS
V)D'( 4°i i
CONTRACTOR
ADDRESS
%lt?resr�� t`tLf?es
DESIGNER
ADDRESS
CHANGE OF USE FROM
6.
TYPE
7, OF
WORK
ZIP
Cj U/0
PHONE
ZIP
PHONE
ZIP
TO
UJ NEW ❑ ALT. 0 AD N. 0 RPL. ❑ MVE.
❑ BLD. ❑ PLMB. 12( MECH. 0 M.H. 0 POOL
0 OTHER
LEGAL DESCRIPTION — SEE ATTACHED
PARCEL NUMBER/S
Actual Set Backs In Feet
North 'South [East 'West
Zone Classification
Size of Parcel
Type Const.
Occupancy
Valuation
Sprinklered
Oyes ❑No ❑ Req'd.
Building Area In Sq. Ft.
Main Floor Upper Floors Garage Area I Storage
Area of Decks Finished Basement Unfin. Basement
No. Baths
No. Stories
No. Rooms No. of Dwellings
DESCRIBE WORK
Ln 1' 3 >= v (L I\hn;.71 i'. f i-k01'Y C
VALUATION
9.
SOURCE
OF
UTILITIES
GAS
ELECTRIC
WATER
SEWER
CERTIFICATE
of EXEMPTION
Location (Area)
Enum. Dist.
Req'd. Rec'd. Not Req'd.
Ownership
Public ❑ Private ❑
USE CODE
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 INSPEC
DATE OF APPLICATION L l/ /SIGNATURE OF APPLICANT
SPECIAL APPROVALS
NAME DATE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
Bing Technician
SPECIAL CONDITIONS:
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL $
PERMIT NUMBER
kI�(vl {v8
0'4* *1200
*12,00 ro
*12,006
A *0.00 8
62672
06-24-8:1
6479,
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
i0:1
61;24 _{8;1i
DATE ISSUED
62 6,8'z
PERMIT NO.
*10'0 a,11- -
TOTAL