1981, 04-17 Permit: 81A-3666 Chimney, WoodstovePLAN NUMBER APPLICATION/PERMIT
SPOKANE COUNTY - BUILDING CODES DEPARTMENT
J NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
v APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
JOB ADDRESS
1. Sr l j O v MAIC. j,i LEGAL DESCRIPTION — SEE ATTACHED
LOT BLOCK UB I ION PARCEL NUMBER/S
2. ( h 1 ✓�✓� �efi�
OWNER
3. -1 00 N
ADDRESS
167, 110
CONTRACTOR
4. ADDRESS
DESIGNER
5. ADDRESS
15.
{ / \N V -f f
PHONE
::�2A - l
E
ZIP
PHONE
ZIP
actual Set Backs in Feet
TO
)rth
South
East West
ze of Parcel
Zone Classification
Ty�p/e onst.
pl�Lcu ancy
Sprinklered
^/
' Y
❑Yes []No ❑ Req'd.
3luation
I Building Area in Sq. Ft.
Main Floor I Upper Floors I Garage Area I Storac
CHANGE OF USE FROM
TO
Area of Decks
Finished Basement
Unfin. Basement
6.
No. Baths
No. Stories
No. Rooms
No. of Dwelling
TYPE dilME W C1ALT. ❑ D'N. 11 RPL. ElMVE.
7, OF E]OTHER
CERTIFICATE
Req'd.
Recd.
Not d
LLL��� BLD. ❑ PLMB. MECH. ❑ M.H. ❑ POOL
WORK
of EXEMPTION
DESCRI EWO K Enum. Dist. Location (Area)
8 /�_P,� �LI 4 vi 0 FEES COLLECTED
ISSOURCEGAS
VALUATION ELECTRIC WATER SEWER Ownership SE CODE
9. �OQ UTILOITIES Public El Private
Single $
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
�®
Building
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 nstruction or the
performance of construction. SEE REVERSE SIDE FOR REQUIRED INSPECTIONS
Plumbing
Mech. 1-7
DATE OF APPLICATION SIGNATURE OF APPLICANT
SPECIAL APPROVALS SPECIAL CONDITIONS:
NAME DATE
I
Plan Check
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
Built�'ng T�jh. �n
PERMIT IS NONTRANSFERABLE
SEPA
Mobile Home
Other (Specify)—
TOTAL
Specify)TOTAL $
PERMIT NUMBER
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
0 '4� 1� T J 1 3 6'6, 6 25
*2'Z00aF1