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1981, 04-22 Permit: 81A-3833 ChimneyPLAN NUMBER ii/a3/g( 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. 72 e 2Q -c tee_ LOT BL CK SUBDIVISION LEGAL DESCRIPTION — SEE ATTACHED 2. OWNER /- 3. Ste n' P 71/' J/l1 /� e ADDRESS NTRACTOR �. � /) Y, ADORE$Sfi, 4 .7( o2 / L*/ ,/ DESIGNER J�:�/1���, '�%��_�� 5. PHONE y..2a- o VCS PARCEL NUMBER/S 14Y. (26Z2— ZIP PHONE yf�sy7� ZIP 71�n PHONE ADDRESS ZIP Actual Set Backs in Feet North 'South East 'West Size of Parcel Zone Classification Typ Const. Occupancy Sprinklered ck.-11 ❑Yes ❑No ❑ Req'd. Valuat' n Building Area In Sq. Ft. Main Floor Upper Floors Garage Area Storage CHANGE OF USE FROM 6. TYPE 7. OF WORK TO Area of Decks Finished Basement Unfin. Basement ❑ NEW ❑ BLD. DESCRIBE WORK 8. VALUATION ❑ ALT. ❑ PLMB. ❑ AD'N. ❑ MECH. ❑ RPL. ❑ M.H. ❑ MVE. ❑ POOL 0 OTHER No. Baths No. Stories No. Rooms No. of Dwellings CERTIFICATE of EXEMPTION Enum. Dist. Location (Area) Req'd. SOURCE OF UTILITIES GAS ELECTRIC WATER SEWER Ownership 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 INSPECTIINS DATE OF APPLICATION / SPECIAt APPROVALS NAME DATE Env. Health Plano U1g Fire Marshall Co. Engineer Utilities Plans Examiner SEPA Checklist B cng nician .97 SIGNATURE OF APPLICANT SPECIAL CONDITIONS: PERMIT IS NONTRANSFERABLE Rec'd. Not f q'd. FEES COLLECTED Single $ Building▪ O/ 'e,C, Plumbing Mech. Plan Check SEPA Mobile Home Other (Specify) TOTAL PERMIT NUMBER StA-31 t33 02* *1000 * 10.00 N * 10.006 A *0.00 8 383.2 04-23-81 2 6479. WHEN MACHINE VALIDATED IN THIS SPACE, THIS BECOMES A PERMIT. 0'41-23-81 38331 *10.00a�- PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE DATE ISSUED PERMIT NO. TOTAL