1982, 08-05 Permit: 82A-6820 Chimney W/WoodstovePLAN 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
t_•
BLOCK
LOT
C.. *—k.` TA ,Av,✓
LEGAL DESCRIPTION - SEE ATTACHED
SUBDIVISION
Rtot A000rioN)
OWNER
3. t•4 c�G41 t c
ADDRESS
4.
PHONE
CI -C/r--E3-12-
PARCEL NUMBER /S
675(43-22a-5
• q:•O"<. . A rA A.••
CONTRACTOR
ADDRESS
'#i �nC
ZIP
PHONE
Actual Set Backs in Feet EXc f r
North (South East 'West
Zone Classification
Size of Parcel
ZIP
Type Const.
Occupancy
Sprinklered
❑Yes ❑No ❑ Req'd.
DESIGNER
PHONE
ation
cc .
Building Area in Sq. Ft.
ADDRESS
ZIP
Main Floor
Upper Floors
Garage Area
Storage
CHANGE OF USE FROM
6.
TO
Area of Decks
Finished Basement
Unfin. Basement
TYPE
7, OF
WORK
IdNEW ❑ ALT. ❑ AD'N. ❑ RPL. ❑ MVE.
F'BLD. ❑ PLMB. 1Y1/MECH. ❑ M.H. ❑ POOL
❑ OTHER
No. Baths
No. Stories
No. Rooms
No. of a Dwellings
DESCRIBE WORK
mA5o ) C cv' Nei
VALUATION SOURCE
OF
9. UTILITIES
GAS
CERTIFICATE
of EXEMPTION
Enum. Dist. I Location (Area)
Req'd.
Rec'd.
N ot F3,eq'
ELECTRIC 1 WATER
SEWER
Ownership 10,4 USE CODE
Public ❑ Private
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 APPLICATIO
SIGNATURE OF APPLICANT x /" J3C44..e
SPECIAL APPROVALS SPECIAL CONDITIONS:
NAME DATE
Env. Health
-Na7 +"2''!)
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
• ing Technician
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
FEES COLLECTED
Single $
Building -z0.cx
Plumbing
Mech. 4 12-0.00
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL $ •00
PERMIT NUMBER
652 _,ft -(.oe•
02* *2000
04* *2000
*4000 to-
*40.006
A *0.00
681.92
08 -05 -82
6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
08 05 82• 682'02
DATE ISSUED PERMIT NO.
*4O.00aI -,