1979, 08-14 Permit P79-1689 Plumbing Fixtures111111111....
PLAN 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 4 COPIES
JOB ADDRESS
I-_
LOT
2.
OWNER
3.
BLOCK
PHONE
LEGAL DESCRIPTION - SEE ATTACHED
PARCEL NUMBER/S
ADDR ESS
ZI P
Required Set Backs in Feet
North (South
East
'West
4.
5.
6.
CONTRACTOR
ADDRESS 5+ 5- !Jtt
D R41r=NFF2 )I7 D
Ik/
ADDRESS
CHANGE OF USE FROM
TO
PD tg_Dx /i/ 2 /
ZIP gg %f]j/
!l�vC7
PH,QN E
86
ZIP
ize of Parcel
Type Const.
Valuation
Occupancy
Zone Classification
Sprinklered
❑Yes ❑No ❑ Req'd.
Building Area in Sq. Ft.
DWL Area I Basement Area Garage Area
Split Entry
Split Level
Storage
Rancher
7.
TYPE
OF
WORK
0-NEW ❑ ALT.
❑ BLD. ❑ PLMB.
❑ AD'N.
❑ MECH:
❑ RPL.
❑ M.H.
❑ MVE-
❑ POOL
❑ OTHER
No. Baths
No. Floors
No. Rooms
Rec. Room
CERTIFICATE
of EXEMPTION
Req'd.
Rec'd.
Not Req'd.
DESCRIBE WORK
8.
VALUATION
9.
Source
of
Utilities
GAS
ELECTRIC
WATER
SEWER
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. Th gra ting of a permit does not presume
to give authority to violate or cancel the provisions of any other state ;law reguu'rig construction or the
performance of construction.
DATE SIGNATURE
DEPT.
SPECIAL APPROVALS
REQ'D. REC'D.
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Zone Clearance
SEPA Checklist
SPECIAL1LONDITIONS:
DATE • 7 OFFI
FEES COLLECTED
1
PERMIT NUMBER
�y
DATE p // /7
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL
03* *4aoo
*4800 ,
*48006
A *0.00
16882
08-07-79
2 6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS B COM APE MIT.
0$-0-7 168,9s5 *48.00ai:'
I nI P O C!`T(1 D
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