1981, 03-23 Permit P81A-2672 Soft WtrPLAN NUMBER
APPLICATION/PERMIT
SPOKANE COUNTY — BUILDING CODES DEPARTMENT
PERMIT NUMBER
y/A--;2-6/�?
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
JOB ADDRESS
• ( 9 W 11 it r /1.�� �'-'
LOT BLOCK SUBDIVISION
2.
3.
4.
OWNER
AbDRESS F
(� 'f %�-d ! /l �// 1i� + n /� cif Imo/
CONTRACTOR
.4
/ //
ADDR• SS
DESIGNER
5' ADDRESS
6.
CHANGE OF USE FROM
TYPE
7. OF
WORK
DE CRI
0 NEW
❑ BLD.
E WOR
VALUlj ION
9.
❑ ALT.
PLMB.
TO
❑ AD N.
O MECH.
❑ RPL.
O M.H.
PHONE
9:. —//) 6,1
ZIP
PHONE
ZIP
PHONE
ZIP
❑ MVE.
❑ POOL
0 OTHER
SOURCE
OF
UTILITIES
GAS
ELECTRIC
WATER
SEWER
LEGAL DESCRIPTION — SEE ATTACHED
PARCEL NUMBER/S
Actual Set Backs in Feet
North 'South
Size of Parcel
East 'West
Zone Classification
Type Const.
Valuation
Occupancy
Main Floor Upper Floors
Sprinklered
❑Yes ❑No ❑ Req'd.
Building Area in Sq. Ft.
Garage Area
Area of Decks I Finished Basement
Storage
Unfln. Basement
No. Baths I No. Stories No. Rooms INo. of Dwellings
CERTIFICATE •
of EXEMPTION
Enum. Dist. Location (Area)
Req'd. Rec'd. Not Req'd.
Ownership
Public 0 Private ❑
USE CODE
1 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
SIGNATURE OF APPLICANT
SPECIAL APPROVALS
NAME DATE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
SPECIAL CONDITIONS:
FEES. COLLECTED
Single
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify/
Y
11
TOTAL $ `5 p
$
03* *5.0,0
*5.00
*5.006
A *0.00 n
267,'1�
03-23-8,1
6,479,
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
Bu
ilding
Tec niciapy
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
0 ►3j 213i,- ,11
DATE ISSUED
267::2.2
PERMIT NO.
0.0 d O.
TOTAL