1981, 11-16 Permit G81B-1819 Gas PipePLAN NUMBER
APPLICATION/PERMIT
SPOKANE COUNTY —SUM-DING CODES DEPARTMENT
PERMIT NUMBER
eI$
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 3 COPIES
1,
2.
JOB ADORES / f er /
LOT
BLOCK
SUBDIVISION
3.
OWNER
e
ADDRESS
CONTRACTOR
4.
ADD
/ 14, '
DESIGNER
5' ADDRESS
.A. ; t
42.4e,z-
l&
PHONE
ZIP
PHONE
ZIP
PHONE
North
Size of Parcel
Type Const.
Valuation
LEGAL DESCRIPTION - SEE ATTACHED
PARCEL NUMBER/S
Actual Set Backs in Feet
'South lEast
Occupancy
West
Zone Classification
Sprinklered
Lives ❑No 0 Req'd.
Building Area in Sq. Ft.
ZIP
Main Floor
Upper Floors 1 Garage Area
Storage
CHANGE OF USE FROM
6.
TYPE
7. OF
WORK
TO
4 NEW ❑ ALT. ❑ AD'N.
❑ BLO. ❑ PLMB. .a MECH.
❑ RPL.
❑ M.H.
El MVE.
❑ POOL
❑ OTHER
DESCRIBE WOfjJS 201'
8. ,
VALUATI0 4
9.
SOURCE
OF
UTILITIES
GAS
e 7/, or
EIIECTRIC
WATER
SEWER
Area of Decks
No. Baths
Finished Basement
No. Stories
No. Rooms
Unfin, Basement
No. of Dwellings
CERTIFICATE
of EXEMPTION
Enum. Dist. I Location (Area)
rr;7 .' l 1i I
Ownership
Public ❑ Private ❑
USE CODE
Req'd.
Rec'd.
Not Req'd.
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 INSPECTIONS
DATE OF APPLICATION/Y / 1 — < � SIGNATURE OF APPLICANT YV/1619�
SPECIAL APPROVALS SPECIAL CONDITIQNS:
NAME DATE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
,t„[ Ni
rr
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL
0
04* * 1 2,00
*1200
*12.006
A *0,00
181.82
11-16-81
6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
rll r PllpV
Bu§ing T,e�hnician
PERMIT IS NONTRANSFERABLE
11 1G--81
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE DATE ISSUED
1819z
PERMIT NO.
*1200°.-12
TOTAL