1983, 06-16 Permit: 83A-5394 ChimneyPLAN NUMBER
APPLICATION/PERMIT
SPOKANE COUNTY - DEPARTMENT OF BUILDING & SAFETY
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 3 COPIES
STREET ADDRESS
1. . -r1
2. 1 2
LOT BLOCK
-
rJ t r4
SUBDI ISION
N� r o I k M' /coo..
3 OW R1 1A0 r4
MAILING ADDRESS
CONTRA TO 6
4.
ADDRESS
PHON
7 X75
LICENSE EXPIRES
DESIGNER
ADDRESS
CHANGE OF USE FROM
PHONE
IP
•tom
PHONE
ZIP
PHONE
ZIP
TO
TYPE ❑ NEW ❑ ALT. :21AD'N. ❑ RPL. ❑ MVE.
7. OF ❑ OTHER
WORK•
efEILD. El PLMB. MECH. M.H. POOL
PARCEL NO. 3 315+1 - rJ
LEGAL DESCRIPTION:
Actual Set Backs in Feet to:
North l South r [�
Size of Parcel
TI t\JCI
East
IWest
Zone Classification O
ResidentialZ
Commercial ❑
Type Cont
Occupancy
Sprinklered
❑Yes ❑No Req 'd.
New Const. Valuation Remodeled Valuation
Main Floor
Cover Deck
Upper Floors
Garage/Storage
Total Bldg. Floor Area
No. Baths
Certifi. of Exempt.
or Variance
Uncv. Deck
No. Floors
DESCRIBE WORK
8.
VALUA—ION SOURCE
9. SOC)
OF
UTILITIES
GAS
ELECTRIC
Fin. Basement
Greenhouse
Unfin. Basement
No. Fin. Rooms
Required Yes❑ No
Received Yes No❑
Shorelines/Flood Hazard
YesE Not Applic. ❑
WATER
PUBLIC ❑
PRIVATE El
SEWAGE
SEPTIC ❑
SEWER ❑
Ownership
Public ❑ Privatect
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 au-
thority to violate or cancel the provisions of any other state or local law regulating construction or the performance
of construction. SEE REVJ3DEFOR REQUIRED INSPECTIONS
SIGNATURE OF/OWNER OR AGENT//
SPECIAL APPROVALS
PRELIM. FINAL DATE
Env. Health
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
APPLICATION / erg
DATE DATE (� d
SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PERMIT IS NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
No. Dwellings
Number
Plans Required ❑
Received ❑
FEES COLLECTED
Building
Plumbing
Mech.
Plan Check
SEPA
Modular/
MFG. Home
Other (Specify)
TOTAL $
PERMIT NUMBER
-'*
*2000
*20,006
*000
539.3
06-16-83
2 6479.
murrnav
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATE 14.1E
16-83
PERMIT IC;)'. 9. T
* 2 O. 0,tAL