1981, 12-01 Permit: 81B-2325 Fireplace InsertPLAN NUMBER
APPLIC:TIN /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
1.
2.
3.
4.
JOB ADDRESS
�{��7�� Co
LOT I BLOCAL, SUBDIVISION
ckp-
LEGAL DESCRIPTION - SEE ATTACHED
PARCEL NUMBER /S
OWNER
ADDRESS
PHONE
gZE3-31
11115' ,&LotHA cou 2T
CONTRACTOR
(J( L4 t, �T'OOE
ZIP
Actual Set Backs in Feet
North (South East (West
PHONE
Size of Parcel 1 Zone Classification
ADDRESS
" S DC. 7 K)T i t
ZI P
Type Const.
Occupancy
Sprinklered
❑Yes ❑No ❑ Req'd.
DESIGNER
5. ADDRESS
PHONE
Valuation (Building Area in Sq. Ft.
ZIP
Main Floor
Upper Floors 1 Garage Area
Storage
CHANGE OF USE FROM
6.
TYPE
7. OF
WORK
TO
NJ r NEW ❑ ALT. ❑ A N. ❑ RPL. ❑ MVE.
❑ BLD. ❑ PLMB. MECH. ❑ M.H. ❑ POOL
Area of Decks
Finished Basement
Unfin. Basement
❑ OTHER
No. Baths
No. Stories
No. Rooms
No. of Dwellings
CERTIFICATE
of EXEMPTION
Req'd.
Rec'd.
Not Req'd.
DESCRIBE WORK
8. 4:71 QEPLRC& �
VALUATION SOURCE GA EL CTRIC
OF
9. UTILITIES
Enum. Dist. I Location (Area)
WATER
SEWER
Ownership
Public ❑ Private ❑
USE CODE
I hereby certify that 1 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 7
DATE OF APPLICATION
SIGNATURE OF APPLI
SPECIAL APPROVALS
NAME DATE
Env. Health
Planning
r
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
SPECIAL CONDITIONS:
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
FEES COLLECTED
Single $
Building
Plumbing —
1-72
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL $ ` l
PE MIT NUMBER
-2.3z5
J4* *17,00
* 1 7,00
*17006
A *0,00
23242
12-01 -81
2 6479,
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATE ISSUED
23252 *17.00Re-
PERMIT NO. TOTAL