1980, 11-06 Permit: 80B-3323 Fireplace InsertPLAN 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
J B ADDRESS
7 �'
1. 6T BLOCKsusDIVS(ONi `
2.
LEGAL DESCRIPTION - SEE ATTACHED
O ER
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ODRESS
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C NTRACT R
,ft.4r
4' ARIDRESS
DESIGNER
5. ADDRESS
PHONE
f244..377
ZIP
PARCEL NUMBER'S
Actual Set Backs in Feet
North 'South 'East West
PHONE
ZIP
PHONE
ZIP
Size of Parcel 1 Zone Classification
Type Const.
Occupancy
Sprinklered
❑Yes ❑No ❑ Req'd.
Valuation Building Area in Sq. Ft.
Main Floor
Upper Floors 1 Garage Area
Storage
CHANGE OF USE FROM
6.
TO
Area of Decks
Finished Basement
Unfin. Basement
TYPE
7. OF
WORK
❑ NEW 0 ALT. 0 AD N. 0 RPL. ❑ MVE.
0 OTHER
❑ BLD. 0 PLMB. ® MECH. 0 M.H. 0 POOL
No. Baths
No. Stories
No. Rooms
No. of Dwellings
CERTIFICATE
of EXEMPTION
Req'd.
Rec'd.
Not Req'd.
QESCRIBE wpRK
VALUATION
9.
SOURCE
OF
UTILITIES
GAS 1 ELECTRIC 1 WATER
SEWER
Enum, Dist.
Ownership
Public ❑ Private ❑
Location (Area)
USE CODE
I hereby certity 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
r
DATE OF APPLICATION ///".-6 — �/ SIGNATURE OF APPLICANT -ti . 1/ t %!.
dif
SPECIAL APPROVALS
NAME DATE
Env. Health
Planning
t
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
Bu' Ing Tech Ician
SPECIAL CONDITIONS:
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
FEES COLLECTED
Single S
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL
PERMIT NUMBER
S 4 5 -,,a3,2--S
04* *7.00
*7.00
*7.0056
A *0.0c o
3322B p
11-06-80
B 6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
,1:1!-8,6 - 8 0 3 313 * 7.0 0 a '--
DATE ISSUED PERMIT NO.
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