1980, 11-07 Permit 80B-3400 Plumbing FixturesPLAN NUMBER
APPLICATION/PERMIT
SPOKANE COUNTY - BUILDING CODES DEPARTMENT
PEptMIT NUMBER
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
JOB ADDRESS ,
x
BLOK SUBDIQ 1 Nt�
LOT
LEGAL DESCRIPTION — SEE ATTACHED
PARCEL NUMBER/S
3
OVYNER
ADDRESS
ms , S 7/Z. ee
eN
CONTRACTOJI
4. 7`' i% . &". &K,V) S eS
D
AD/2l0 7 , •T
re�17�
DESIGNER
ADDRESS
CHANGE OF USE FROM
6.
TYPE
7, OF
WORK
TO
HONE
ZI P
PtIONE
28'-� Z
ZIP
9'92,
PHONE
ZIP
NEV ❑ ALT.
❑ BLD. ❑ PLMB.
❑ AD'N.
❑ MECH.
❑ RPL.
❑ M.H.
❑ MVE,
❑ POOL
0 OTHER
DESCRIBE WORK
Actual Set Backs in Feet
North South
East
West
Size of Parcel Zone Classification
Type Const.
Occupancy Sprinklered
DYes ❑No ❑ Req'd.
Valuation Building Area In Sq. Ft.
Main Floor
Upper Floors
Garage Area
Storage
Area of Decks
Finished Basement
Unfin. Basement
No. Baths
No. Stories
No. Rooms
No. of Dwellings
CERTIFICATE
of EXEMPTION
Req'd.
Rec d.
Not Req'd.
Enum, Dist.
Location (Area)
VALUATION
9.
SOURCE
OF
UTILITIES
GAS
ELECTRIC//I WATER
SEWER
Ownership
Public 0 Private 0
USE CODE
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 ordinanc :°vermin is
type of work will be complied with whether specified herein or not. The granting of a perm d.es not presume
to give authority to violate or cancel the provisions of any other state or local law regula 'n• nst . tion 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:
4 - Try! s
4- 7-orf-ets
4 — L&vs
4— 1�; S-
q— /7,k"
Focr -- L X'
FEES COLLECTED
Single $
Building
Plumbing do.00
Mech.
Plan Check
SEPA
Mobile Home
Ot er (Specify) 3 00
J
TOTAL $ {C{C�'3.00
03* *60.00
*60,00
*60,00f,
A *0.00 U
339.92
11=07-80
2 6479.
G1-1 1A1A
Oo De -
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
'a Tec 'an
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
.
-8 0i
DA1�E ISSUED '
PERMIT .0. Q f•