1981, 10-06 Permit: 81B-0309 Chimney, WoodstovePLAN NUMBER
f
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
1.. i�o� r 6-
LV1'e�
LEGAL DESCRIPTION - SEE ATTACHED
BLOCK
SUBDIVISION
LOT
2.
D.
O
3. NT r:\4V � c.'
�tj N1t6,1,1 1\
ADDRESS 1 0 0 0
atiA "al-0 oN1
4.
CO NT AC'TER
"'
P ONE
vi g
IP 42 3
PHONE
PARCEL NUMBER /S
O(5 44 - vP oi-
Actual Set Backs in Feet
North (South East (West
Size of Parcel Zone Classification
ADDRESS
ZIP
Type Cpnt.
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
Area of Decks
Finished Basement
Unfin. Basement
NEW ❑ ALT. LJ AD'N. ❑ RPL. ❑ MVE.
I BLD. ❑ PLMB. Er/MECH. ❑ M.H. ❑ POOL
❑ OTHER
No. Baths
No. Stories
No. Rooms
No. of Dwellings
CERTIFICATE
of EXEMPTION
Req'd.
Rec'd.
Not RKj'd.
DESCRIBE WO K .�a
8. !" �'F 'C�Iv - i
Gt4IN
1,‘;00P7
Enum. Dist.
Location (Area)
VALUATION
9. 50°
SOURCE
OF
UTILITIES
GAS
ELECTRI
WATER
SEWER
Ownership
Public ❑ Private l
USE CODE
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 _�� %� —S12 ._ � SIGNATURE OF APPLICANT
SPECIAL APPROVALS
FJAME DATE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
ec
SPECIAL CONDITIONS:
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
10
1
TOTAL $
PERMIT NUMBER
-
02* * 1 0.00
* 1 0.00
30.72
10-06-81
2 6479.
04* *17,00
* 1 7.00
3082
10 -06 -81
6.479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
10;,06_81
DATE ISSUED
30,95 *'27.00 a -
PERMIT NO. TOTAL