1980, 10-07 Permit: 80B-1518 Chimney(PLAN NUMBER
Y.
Nj
ser-
APPLICATION/PERMIT
SPOKANE COUNTY - BUILDING CODES DEPARTMENT
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
NAPPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3•COPIES
JOB ADDRESS
1. : 717a1-1-1,e-cI&
LOT SUBDIVISION
2.
BLOCK
LEGAL DESCRIPTION — SEE ATTACHED
3.
OWNER/
ADDRESS
CONTRACTO` -
iYJ?1�
PHONE
9n-9/ AZ
P99-2.0 G�
PARCEL NUMBER/5
Actual Set Backs in Feet
North (South [East (West
PHONE
Size of Parcel - 1 Zone Classification
ADDRESS ZIP
Type Const.
Occupancy
Sprinklered
❑Yes ONo 0 Req'd.
5.
DESIGNER PHONE
Valuation
Building Area in Sq. Ft.
ADDRESS • ZIP
4
Main Floor
Upper Floors, I Garage Area
Storage
CHANGE OF USE FROM
6.
TYPE
7. OF
WORK
TO
Area of Decks
Finished Basement
Unfin. Basement
O NEW
❑ BLD.
0 ALT.
0 PLMB.
0 AD N.
0 MECH.
❑ RPL.
❑ M.H.
❑ MVE.
0 POOL
0 OTHER
No. Baths
No. Stories
• No. Rooms
No. of Dwellings
CERTIFICATE
of EXEMPTION
Req'd.
Reed.
Not Req'd.
8.
9.
DESCRIBE WORK /Y e•
•
VALUATION
Enum. Dist.
Location (Area)
SOURCE
OF
UTILITIES
GAS
ELECTRIC
WATER
SEWER
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 INSPECTIONS
DATE OF APPLICATION
SPECIAL APPROVALS
NAME DATE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
Building Technician
SIGNATURE OF APPLICANT
SPECIAL CONDITIONS:
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
FEES COLLECTED
Single $
Building'
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL $ / O
PERMIT NUMBEP
$CICF3 t 8
02* *1Q00
*10.00 V
*10.006
a *0.00
151.5g
10-07-80
3 6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
3 *1000a�
DATE ISSUED PERMIT NO. TOTAL
Y
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O
U
W
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WHEN
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