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1980, 11-07 Permit: M80B-3396 Chimney
PLAN 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 4 COPIES 1. 2. 3. JOB ADDRESS (r3 ©3 M LEGAL DESCRIPTION - SEE ATTACHED LOT BLOCK SUBDIVISION PARCEL NUMBER /S OWNER (--- �, tr.k w.�1� ADDRESS E, ;3b3 Ili CONTRACTOR 4. Ck Kev 't,A) c -Et ADDRESS s . I00).- Per rtii DESIGNER 5. tDiklr4,L —}— e)V ADDRESS PHONE lo 30 Required Set Backs in Feet North 'South East 'West PHONE Size of Parcel 1 Zone Classification '019)-o)._ Type Const. Occupancy Sprinklered ❑Yes ❑No ❑ Req'd. PHONE Valuation 1 Building Area in Sq. Ft. ZI P DWL Area I Basement Area r Garage Area I Storage CHANGE OF USE FROM 6. TYPE 7. OF WORK TO Split Entry Split Level Rancher ❑ NEW ❑ ALT. IEl AD'N. ❑ RPL. ❑ MVE. ❑ BLD. ❑ PLMB. !!!❑ MECH. ❑ M.H. ❑ POOL ❑ OTHER No. Baths No. Floors No. Rooms CERTIFICA TE of EXEMPTION Req'd. Rec. Room Rec'd. Not Req'd. DE CRIBE WQRK 8. hs ail Cl55A- Me +t1 e�.i}w► ~ e VALUATION I G45 9. Source of Utilities 1\eartcirNotii -eci-1 SEWER 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. T e granting of a permit does not presume to give authorit to violate or cancel the provisions of any other state r local law regulating construction or the performance o cons uction. DATE DEPT. Env. Health Planning Fire Marshall Co. Engineer Utilities SIGNATURE SPECIAL APPROVALS REQ'D. REC'D. Zone Clearance SEPA Checklist SPECIAL CONDITIONS: DATE/ l OFF AP IS S I FEES COLLECTED Single $ Building Plumbing Mech. Plan Check SEPA Mobile Home Other (Specify) 7 evfl TOTAL $ DATE PERMIT NUMBER u4* *7.00 *7.00 *7.00 A *0,00 339,52 11 =07 -80 z 6479, WHEN MACHINE VALIDATED IN THIS SPACE, THISBECOM A`PERMIT. 111 -. f Z. -e8 `o 3 3 9.6 , *7.0021:' R ISSUANCE m m )> C/) m 0 - 0 MI ., • 0 1111 Cl) r11 0 C:3 Le- Cn I • 1 - Z Cl) m c-) -n 0 co .0i/1 co —! -o C-) • 0 GI r