1990, 05-17 Permit App 90002172 Residence, GarageSPOKANE COUNTY DEPARTMENT OF BUILDING AND SAFETY
W. 1303 BROADWAY AVENUE
SPOKANE, WASHINGTON 99260
(509) 456-3675
I certify that I have examined this permit/application, state that the information contained in it and submitted by me or my agent to compile said permit/application is true
and correct, and authorize Spokane County to proceed with processing. In addition, I have read and understand the INSPECTION REQUIREMENTS/NOTICE
provisions included herein and agree to comply with same. All provisions of laws and ordinances governing this type of work will be complied with whether specified
herein or not. I understand that the issuance of this permit/application and any subsequent inspection approvals or Certificates of Occupancy shall not be construed to
give authority to violate or cancel the provisions of any state or local law regulating construction, or as a warranty of conformance with the provisions of any state or local
laws regulating construction.
SIGNATURE OF APPLICATION
OWNER OR AGENT DATE
PROJECT NUMBER_: 90002172
APFLICATioN
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EEI AC::K REVIEW REQUIRED
ENERGY PLAN REVIEW REQUIRED
APPROACH/FLOOD PLAIN/DRAINAGE
NEW OR ADDITIONAL I.4ArTE_ WATER
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SPOKANE WA .22Z5
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1D91 PlF
44D d Spokane County
2DEPARTMENT OF BUILDING & SAFETY
a-o West 130Broadway Avenue Spokane, WA 99260 (509) 456-3675
INFORMATION WORKSHEET
(/ PARCEL NUMBER: 1 �l C o,
STREET ADDRESS: /'`(°`l73 0 n 4 c- y
CITY/STATE/ZIP: l
SUBDIVISION: pLG /-15zA42/&S ,4 i O ,.
BLOCK: / LOT:-3 ZONE: DISTRICT:
LOT AREA: //// 5— F/,x°: WIDTH: 7 -73 DEPTH: /V6 R/W:
# OF BUILDINGS: # OF DWELLINGS: / WATER DISTRICT: j1,,42J14,
OWNER: 2 iZ1 a , C/g.4 PHONE: S G7 - / c 2 U
MAILING ADDRESS: Lc) c /''1'7 C9 /%/-L/¢/U 4
CITY/STATE/ZIP: G / /11 IA) if St(
CONTACT: G 1 Fti
PHONE: 5 - - /0F()
SETBACKS: - FRONT: LEFT: %a.- RIGHT: 3 REAR:
PERMIT USE:
****************************************************************************
BUILDIING INFORMATION?
CONTRACTOR LICENSE NUMBER: k),"CJ � (1 SR/
CONTRACTOR: ji..S •v'1 CQ PHONE: 565 - .3.21 - %G 5 6)
MAILING ADDRESS:
ARCHITECT/ENGINEER: PHONE:
MAILING ADDRESS:
NEW:y REMODEL: ADDITION: CHANGE OF USE:
DWELL UNITS: OCCUPANT LOAD: BUILDING HGT: /7 1 STORIES:
BUILDING DIMENSIONS: /ice X (WIDTH X DEPTH) SQ. FT.: JCS ?/
REQUIRED PARKING: # HANDICAP: SPRINKLERED: CRITICAL MATERIAL:_
PLUMBINGL PERMIT APPLICATION FORM
Information Worksheet
JOB STREET ADDRESS:
CITY/STATE/ZIP: PARCEL NUMBER:
OWNER: PHONE NUMBER:
MAILING ADDRESS:
CONTRACTOR:
(Street)
MAILING ADDRESS:
(City/State) (Zip)
LICENSE NUMBER:
PHONE NUMBER:
(Street)
(City/State) (Zip)
PLUMBING WORKSHEET/FEE SCHEDULE
DESCRIPTION
NUMBER OF
FIXTURES
X EACH
FIXTURE
= AMOUNT
TOILETS
SINKS
SHOWERS
BATH TUBS
KITCHEN SINKS
DISH WASHERS
GARBAGE DISPOSAL
CLOTHES WASHER
UTILITY SINKS
ELECTRIC WATER HEATERS
FLOOR DRAINS
FLOOR SINKS
BAR SINKS
ROOF DRAINS
LAWN SPRINKLER
SEWAGE EJECTOR
WATER SOFTENER
URINAL
DRINKING FOUNTAIN
x $6.00 =
x 6.00 =
x 6.00 =
x 6.00 =
x 6.00 =
x 6.00 =
x 6.00 =
x 6.00 =
x 6.00 =
x 6.00 =
x 6.00 =
x 6.00 =
x 6.00 =
x 6.00 =
x 6.00 =
x 6.00 =
x 6.00 =
x 6.00 =
x 6.00 =
NOTE: MINIMUM PERMIT FEE IS $35.00
SIGNATURE
SUBTOTAL
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
$
Spokane County Department of Building and Safety
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675
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TYPE OF SEWAQ! SYSTEM, O!Flrl4H8
LINEAL OR SQUARE FOOIAG
TRENCH WPOtH,
DEPTH FROM OFGNAL GROUND S F
OF SE'hr,g^F cad $pTT M
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