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