1980, 11-07 Permit: 80B-3388 FireplaceR 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
/ LEGAL DESCRIPTION — SEE ATTACHED
LOT I BLOCK ISUBE51VISION PARCEL NUMBER/S
2.
OWN P ONE
3. J
AD SS
ZIP
Actual Set Backs in Feet
9.2-0
19
North South East West
CONTRACTOR
PHONE
Size of Parcel
Zone Classification
4' ADDRESS
ZIP
Type Const.
Occupancy
Sprinklered
❑Yes ❑No ❑ Req'd.
DESIGNER
PHONE
Valuation
Building Area in Sq. Ft.
5.
ADDRESS
ZIP
Main Floor I Upper Floors
Garage Area
I Storage
CHANGE OF USE FROM
TO
Area of Decks
Finished Basement
Unfin. Basemen
6.
Baths
No, Stories
No. Rooms
No. of Dwelli
TYPENo.
❑ NEW ❑ALT. ❑ AD'N. ❑ RPL. ❑ MVE.
%_ OF C3 OTHER
1:1 BLD. 11PLMB. ElMECH. El m. 1:1POOL
CERTIFICATE
Req'd.
Recd.
Not Rei
WORK
of EXEMPTION
DESCRIBE WORK
Enum. Dist.
Location (Area)
FEES COLLECTED
8 cC
VALUATION
SO E
GAS ELECTRIC
WATE SEWER
Ownership
USE CODE
9.
F
UTILITIES
Public El Private C1Single
$
1 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
Building
to give authority to violate or cancel the provisions of any other state or to law regulating construction or the
performance of construction. SEE REVERSE SIDE FOR REQUIRED INOECT-IZPNS
Plumbing
DATE OF APPLICATION S[7 SIGNATURE OF APPL
Mech. 4 -
SPECIAL APPROVALS
NAME DATE
nv. Health
anning
ngineer
Utilities
Plans Examiner
SPECIAL CONDITIONS:
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL $ �---
PERMIT NUMBER
0C�* *7.00
*7.00
3387
a 6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATE IStUED PERMIT NO.
*7..00IOL r
TOTAL
n
R
r