1981, 05-14 Permit: 81A-4694 ChimneysPLAN 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
CAKt.
'. 01 LOT BLOCK I SUBDIVISION
H7 fk / l s • �
OW N�j�F' Rte, _ eJ' rr tJOGt i � ✓ E
a AD DRES5e1 L✓ 9
CONTRA T/qR
4 V
2.
LEGAL DESCRIPTION SEE ATTACHED
4.
PHONE
9�}&e-9 f -i9
✓%7•o 0
PARCEL NUMBER/5 O 75 1 2_ -ce507
N
1oo1.6r t..aC0or �. 147.S6
Actual Set Backs in Feet
North 'South .
East (West
PHONE
Size of Parcel Zone Classification
ADDRESS
ZIP
' Typpaonst.
DESIGNER
b. ADDRESS
PHONE.
Valuation
Occupancy • Sprinklered
r{K7f Oyes ❑No ❑ Redid.
Building Area in Sq. Ft.
ZIP
Main Floor
Upper Floors.
Garage Area
Storage .
CHANGE OF USE FROM
6.
TO
Area of Decks
Finished Basement'
Unfin. Basement
TYPE OpleW- - 0 ALT. el. AD N. 0 RPL.
7. OF.
WORK BLD. 0 PLMB. 0, M-E�/CH. 0 M.H.
8.
DES C - RI( R 4I f IV TRIC Vl
WO
VA LATION SOUR
9. GO UTILITIES
OF
O MVE
❑ POOL
0 OTHER
No. Baths
No. Stories
No. Rooms
No. of Dwellings
CERTIFICATE
of EXEMPTION
Req'd.
Recd.
Not Re4'tl:
Enum. Dist.
Location (Area)
WATER
SEWER
Ownership
Public 0 Private
rii/USE 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 permitdoes 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 ��^�� SIGNATURE OF APPLICANT V/f0.!(
SPECIAL APPROVALS SPECIAL CONDITIONS:
NAME 'DATE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
FEES COLLECTED
Single $
Building
- Plumbing ..
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL
$ /a° -e'.
PERMIT NUMBER
— 4-094-
02* *10.00
* 10.00 .
* 1 0.006
A . *Q00 3
469.38
05L 1 - 8a1
2 6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
'0 l5'�3ij41 B'11 46 9 4''Z
, *1 `0.0.0:240
DATE ISSUED , PERMIT NO. TOTAL