1982, 10-12 Permit: 82A-9389 ChimneyPLAN 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
LO Ld p
LOT BL C
2
OWNER
3�
ADD ESS I 1 &Ka AL-161J -CPC
CONTRq.CTQ�
4' ADDRESS
ISI N
SUBDIVISI N
LEGAL DESCRIPTION - SEE ATTACHED
DESIGNER
ADDRESS
CHANGE OF USE FROM
6.
TYPE
7. OF
WORK
8.
PHO E
/Z.IP
PHONE
ZIP
PHONE
ZIP
TO
PARCEL NUMBER /S
o -_
Actual Set Backs in Feet r7fI I
North 'South East
West
Size of Parcel Zone Classification
Type Const.
Occupancy
Sprinklered
Oyes ❑No ❑ Req'd.
Valuation
Main Floor
Area of Decks
Upper Floors
Building Area in Sq. Ft.
Garage Area
Finished Basement
Storage
Unfin. Basement
No. Baths
No. Stories No. Rooms
No. of Dwellings
Not Re
NEW
❑ ALT.
❑ PLMB.
❑ AD N.
❑ MECH.
❑ RPL.
❑ M.H.
DESCRIBE WORK 5,,.,f/
VALUA
9.
ION
00
SOURCE
OF
UTILITIES
GAS
ELECTRIC
❑ MVE.
❑ POOL
WATER
❑ OTHER
CERTIFICATE
of EXEMPTION
Enum. Dist.
Location (Area)
Req'd. Rec'd.
N.
FEES COLLECTED
SEWER
Ownership
Public ❑ Private 41
E CODE
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 APPLICATION P .� �� ^C� SIGNATURE OF APPLICAN
SPECrAL APPROVALS
NAME DATE
Env. Health'
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
SPECIAL CONDITIONS:
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
Single $
Building 2—"
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL
$
PERMIT NUMBER
gy.
02* *2000
93882
10 -12 -82
2 6479,
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
10. -1`2 -'8 2' 93 8.9 z *20.1302F-1 -
DATE ISSUED
PERMIT NO. TOTAL
r
Q-
CD
C.)