1980, 05-16 P-80-4892 Wtr Pipe, Hose Bib`PLAN NUMBER
APPLICATION/PERMIT
SPOKANE COUNTY — BUILDING CODES DEPARTMENT
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (609) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
JOB ADDRESS
1. E, i,C>(,,('a�
LOT
2.
B OCK
OWNER
3.
4' ADDRESS
VYIL
DESIGNER
V <-LC1/4/\I
LEGAL DESCRIPTION — SEE ATTACHED
SUIJU I VISION
PARCEL NUMBER/S
PHONE
ADDRESS
10Co (59 V AL( (T I V'.1 vt'-!
CONTRACTOR
r�AVI'�c-
ZIP
PHONE
ZIP
PHONE
Actual Set Backs in Feet
North (South
Size of Parcel
Type Const.
Valuation
Occupancy
East 'West
Zone Classification
Sprinklered
❑Yes ❑No ❑ Req'd.
Building Area in Sq. Ft.
ADDRESS
CHANGE OF USE FROM
6.
TYPE
7. OF
WORK
ZIP
TO
❑ NEW 0 ALT. 0 AD'N. 0 RPL. 0 MVE.
❑ BLD. i PLMB. 0 MECH. 0 M.H. ❑ POOL
0 OTHER
DESCRIBE WORK
8.
VALUATION
9.
SOURCE
OF
UTILITIES
GAS
ELECTRIC
WATER
Main Floor Upper Floors
Garage Area
Area of Decks
Finished Basement
No. Baths
No. Stories
CERTIFICATE
of EXEMPTION
Enum. Dist.
Storage
Unfln. Basement
No. Rooms
No. of Dwellings
Location (Area)
Req'd. Rec'd.
SEWER
Ownership
Public ❑ Private 0
USE CODE
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 re sting construction or the
performance of construction. SEE REVERSE SIDE FOR REQUIRED INSPECTION
DATE OF APPLICATION / / Cn A'L}
SIGNATURE OF APPLICANT
(.)
SPECIAL APPROVALS
NAME DATE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
SPECIAL CONDITIONS:
C31 \! Z V\// TEP?.
'mac) 2.AC,vi.7L \€.4 1-\
Not Req'd.
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL
$
PERMIT NUMBER
0 3 * *5.5 0
*5.50
*a50�
1 .
E *Q00 I
489.1�
0.5-16.-80
2 6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
Building Technician
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
0.5zr`16'-8'0 4 89, 2 5 * 5. 5 0 2 -
DATE ISSUED
PERMIT NO. TOTAL