1980, 10-07 Permit G80B-1527 Gas PipingPLAN NUMBER
APPLICATION/PERMIT
SPOKANE COUNTY - BUILDING CODES DEPARTMENT
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
JOB ADDRESS
LOT
OWNER
3.
BLOC SUBDIV1SIi
ADDRESS
PHONE
ZIP
LEGAL DESCRIPTION — SEE ATTACHED
PARCEL NUMBER/S
Actual Set Backs in Feet
North South
CONT CTOR
4. • (,'i YX)
ADDRESS
•
DESIGNER
5' ADDRESS
CHANGE OF USE FROM
6.
TYPE
7. OF
WORK
O NEW
O BLD.
❑ ALT.
O PLMB.
// /
PHONE
ZIP
TO
❑ AD'N.
❑ MECH.
❑ RPL.
0 M.H.
0 MVE.
D POOL
0 OTHER
Size of Parcel
Type Const.
DESCRIBE WOR
8.
VALUATION
9.
SOURCE
OF
UTILITIES
GAV
C7RIC,/
-L L Dry
WATER
Main Floor
Occupancy
Upper Floors
Area of Decks
No. Baths
Sprinklered
❑Yes ❑No 0 Req'd.
Building Area in Sq. Ft.
Garage Area
Finished Basement
No. Stories
CERTIFICATE
of EXEMPTION
Enum. Dist.
Storage
Unfin. Basement
No. Rooms
Location (Area)
SEWER
Ownership
Public ❑ Private ❑
Req'd.
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 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 AP- /- Yo
SIGNATURE OF APPLICANT
SPECIAL APPROVALS
NAME DATE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
SPECIAL CONDITIONS:
Rec'd.
Not Req'd.
FEES COLLECTED
Single $
Building
Plumbing
Mech. .!' L1u
Plan Check
SEPA
Mobile Home
Other (Specify)
PERMIT NUMBER
1 C L '!
17-50
64
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
ildin
ician
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
DATE ISSUED
PERMIT NO. TOTAL