1983, 08-30 Permit: 83A-8367 Chimney InspectPLAN 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 pJ.ADDRESS
4704- Lilo.,
fC�
I Lu
1 LOT 44 SUBDIVISIONIIS
2.
BLOCK
3.
rz-r J c-,0,1
MALLING A.,, -7d 4_ G'
CO'VTRAL�CTOR'AT /
4. ADELSS 0
DESIGNER !/
5.
ON
38Y7
LICENSE EXPIRES
PHONE
PARCEL NO.
LEGAL DESCRIPTION:
OggIIE .�-7Q./}
7,2.0G
E G
HO
Actual Set Backs in Feet to:
North (South
Size of Parcel
[East
West
Zone Classification
Residential 0
Commercial D
Type Const.
Occupancy
Spr nklered
Oyes ONo DReq Id.
New Const Valuation
Remodeled Valuation
Total Bldg. Floor Area
ADDRESS
ZIP
Main Floor
Upper Floors
Garage/Storage
Greenhouse
6.
CHANGE OF USE FROM
TO
Cover Deck
Uncv. Deck
Fin Basement
Unfin. Basement
TYPE 2(NEW D ALT. 0 /AAD'N. 0 RPL. 0 MVE.
7. OF
0 BLD. 0 PCMB. II'MIECH. 0 M.H. 0 POOL
WORK
0 OTHER
No. Baths
No. Floors
No. Fin. Rooms
No Dwellings
Calif i. of Exempt.
or Variance
Required YesD No❑
Received VesO No❑
Number
8.
DE CIBE WORK
Shorelines/Flood Hazard
YesD Not Aeolic. 0
Plans Requ'red 0
Received 0
9.
VALUATION 1 SOURCE GAS
OF
UTILITIES
ELECTRIC
WATER
PUBLIC 0
PRIVATE 0
SEWAGE
SEPTIC 0
SEWER 0
Ownership
Public 0 Private 0
I hereby certify that I have read and examined this appl cation 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 tate or al law regulating construction or the performance
of construction. SEE REXER.S SIDE B6R REOUIR INSPECTIONS
SIGNATURE OF
OWNER OR AGENT
SPECIAL APPROVALS
PRELIM. FINAL DATE
Env. Health
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
APPLICATION
DATE
b'3
SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
wOO s'roJ' r i< IN ILL 3E
l [R-69 N rJ I IJ s-tNaJ
PERMIT IS NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
FEES COLLECTED
Building
Plumbing
Mech.
Plan Check
SEPA
Modular/
MFG. Home
Other (Specify)
Std
TOTAL $
PERMITUM R
fr3 3(07
02* *800
83662
08-30-83
6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
its +, .L : c'4
jj( �j 7d
DATASSUEU'
0 — 8'3 PERMIY N�. `" / 2
*8. 0 O 04AL