1980, 03-20 Permit: M-80-2437 FireplacePLAN NUMBER
APPLICATION /PERMIT
SPOKANE COUNTY - BUILDING CODES DEPARTMENT
PERMIT NUMBER
M q0 -aW 3�1
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456 -3675 DATE
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 4 COPIES
JOB ADDRESS
3.
4.
LOT
BLOCK
'/ 2 / AIR
SUBDIVISION
OWNER
4i'i4 /l Ale /� cod-
A ,4i) fid 7»s'P
LEGAL DESCRIPTION — SEE ATTACHED
PHONE
9& '763
ZIP
PH NE�`
/7 /17
PARCEL NUMBER /S
Required Set Backs in Feet
North 'South
East 'West
Size of Parcel
Zone Classification
Type Const.
Occupancy
Sprinklered
❑Yes ❑NO ❑ Req'd.
DESIGNER
5' ADDRESS
PHONE
Valuation
Building Area in Sq. Ft.
ZIP
DWL Area 1 Basement Area
Garage Area
Storage
CHANGE OF USE FROM
6.
TO
Split Entry
Split Level
Rancher
TYPE
7. OF
WORK
❑ NEW ❑ ALT. ❑ AD'N. ❑ RPL. ❑ MVE.
❑ BLD. ❑ PLMB. .'MECH: ❑ M.H. ❑ POOL
❑ OTHER
No. Baths
No. Floors
No. Rooms
Rec. Room
CERTIFICATE
of EXEMPTION
Req'd.
Rec'd.
Not Req'd.
DESCRIBE WORK
VALUATION
9.
Source G
of
Utilities
EL
TRIC
WATER
SEWER
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 riot. 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.
DATE
SIGNATURE
SPECIAL APPROVALS
DEPT. REQ'D.
Env. Health
REC'D.
Planning
Fire Marshall
Co. Engineer
Utilities
Zone Clearance
SEPA Checklist
SPECIAL CONDITIONS:
for gas;
PIPE SIZES:
PIPE LENGTHS:
BTU'S:
DAT E. /QLJI OOFFICIALI�
APPROVED FOR ISSUANCE _
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL $
04* *7.00
*7.00
*7.006
E *0.00
243.68
03 -20 -80
g 6479,
Cc
0
— w
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES f I ,ERMIT.
0'- 2 0 0 243,75
RECORD OF INSPECTIONS
5'
Final Inspection
DATE REMARKS INSPECTED BY
ct 216
,JS