1982, 09-20 Permit: 82A-8427 ChimneyPLAN NUMBER
APPLICATION/PERMIT
SPOKANE COUNTY — BUILDING CODES DEPARTMENT
NORTH 811 JEFFERSON /,.5 OK:y'E, WASHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 3.COPIES
JOB ADDRESS
1. L7K
LOT ' BL K SUBDIVOIN
2.
LEGAL DESCRIPTION - SEE ATTACHED
3.
ADDRESS
' . 17 1q rIr
4.
CON A4
ADDRESS
PHO
ZIP _
PH NE
PARCEL NUMBER/S ;2-754-1 _ f 1 U
Actual Set Backs in Feet N� rel
North 'South East 11
'West
Size of Parcel Zone Classificat on
ZIP
Type fnst.
occi.Aancy
Sprinklered
Oyes ONo 0 Req'd.
5.
DESIGNER
PHONE
Valuation
Building Area In Sq. Ft.
ADDRESS
ZIP
Main Floor
Upper Floors
Garage Area
Storage
CHANGE OF USE FROM
6.
TYPE
7. OF
WORK
TO
Area of Decks
Finished Basement
Unfin. Basement
0� NEW 0 ALT. LSI AD N. 0 RPL. 0 MVE.
L2BLD. 0 PLMB. 0 MECH. 0 M.H. 0 POOL
0 OTHER
No. Baths
No. Stories
No. Rooms
No. of Dwellings
CERTIFICATE
of EXEMPTION
Req'd.
Reed.
Not .91d.
8.
DESCRIBE WOR
ELECTRIC
V Lr-U/ATION
g. / 0 '
SOURCE
OF
UTILITIES
GAS
Enum. Dist.
Location (Area)
WATER
SEWER
USE CODE
Public 0 Private 6J--/
Ownership
I hereby certify that I have read and examined this application and have read the "NOTICE" provisions included
on reverse side, and now 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
performance of construction. SEE REVERSE SIDE FOR REQUIRED INSPECT
DATE OF APPLICATION 7 chi - g2_ SIGNATURE OF APPLICANT
SPECIAL APPROVALS
NAME DATE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
SPECIAL CONDITIONS:'
PERMIT IS NONTRANSFERABLE'
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
FEES COLLECTED
Single $ -,//7
Building 0,
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL $--2-0 .
PEfj MITNUMBER
2 - g4.z7
02* *2000
*20006
A *0.00
84262
b9=20-82
6/!;79.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
O'9a20' ;8i2! $'427'z '*21-O020
DATE ISSUED PERMIT NO. TOTAL
>-
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