1983, 09-06 Permit: 83A-8628 ChimneyPLAN 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
4LEGAL DESCRIPTION - SEE ATTACHED
LOT
2.
BLOCK SUBDIVISION
3.
OWNER
AA S. 14-04)f).
P ONE
' Z4 1 o -
PARCEL NUMBER/S
ADDRESS
-, ''16 el Li F3&R7tf
zIP^
Actual Set Backs in Feet
'South
North
4.
5.
CONTRACTOR
, X4 (lC
ADDRESS
S(Ola_ 'p re '
DESIGNER
PHONE
c -35 4'14{i
Size of Parcel
ZIP n' ,l_Z
Type Const.
Occupancy
PHONE
East (West
Sq.
Zone Classification
Sprinklered
❑Yes ❑No 0 Req'd.
Building Area in
ValuationFt.
ADDRESS
ZIP
Main Floor
Upper Floors Garage Area
Storage
CHANGE OF USE FROM
6.
TO
Area of Decks
Finished Basement
Unfin. Basement
TYPE
7. OF
WORK
❑ NEW 'KALT. 0 AD N. 0 RPL. ❑ MVE.
❑ BLD. 0 PLMB. (MECH. 0 M.H. 0 POOL
0 OTHER
No. Baths
No. Stories
No. Rooms
No. of Dwellings
CERTIFICATE
of EXEMPTION
Req'd.
Rec'd.
Not Req'd.
DESCRIBE WORK
8. Lii G 04, A hz-� �sl Ste„ 6css 6A
VALUATION SOURCE GAS ELECTRIC WATER SEWER
OF
9. UTILITIES
Enum. Dist.
Location (Area)
Ownership
Public 0 Private 0
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 permit does 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 INSPECTI!) S
DATE OF APPLICATION 9' SIGNATURE OF APPLICANT ! . l _A 4 !
SPECIAL CONDITIONS: 41
SPECIAL APPROVALS
NAME DATE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
PERMIT IS NONTRANSFERABLE
a
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL
Z2.
$ ✓1 �.
PERMIT NUMBER
04* *20.00
*20.00Y
A * .. 0 0
8627
09-06-83
5479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.'
09+06'=83 8662.85
*20,00a,1—
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE DATE ISSUED PERMIT NO. TOTAL
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