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1980, 01-08 Permit: M80A-9922 FireplacePLAN 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 4 COPIES JOB ADDRESS gd-z LOT BLO LE 3AL IY SCRIPTION - SEE ATTACHED S 'VISION 2. OWNER 3. AD RESS �f ' ?4,1Xl ° -gra —i`r/, %�� ` h4....' ,/,A.,(24 4 CONTRACTO 4. AD RESS DESIGNER 5. ADDRESS PARCEL NUMBER/S PHONE ZIP 99 IP9 Required Set Backs in Feet North 'South East (West PHONE Size of Parcel 1 Zone Classification ZIP Type Const. Occupancy Sprinklered Dyes ❑No ❑ Req'd. PHONE Valuation 1 Building Area in Sq. Ft. ZIP DWL Area I Basement Area I� Garage Area I Storage CHANGE OF USE FROM 6. TYPE 7. OF WORK TO Split Entry Split Level Rancher ❑ NEW ❑ BLD. ❑ ALT. ❑ PLMB. ❑ AD'N. MECH: ❑ RPL. ❑ M.H. ❑ MVE. ❑ POOL ❑ OTHER No. Baths No. Floors No. Rooms Rec. Room CERTIFICATE of EXEMPTION Req'd. Rec'd. Not Req'd. SCRIBE WORK 8.. ; ^.n� /9 ✓r��; VALUATION 9. ource of Utilities GAS ELECTRIC ( WATER SEWER I hereby certify that 1 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 re. lating construction or the performance of construction. DATE 1 — SIGNATURE . DEPT. SPECIAL APPROVALS REQ'D. REC'D. Env. Health Planning Fire Marshall Co. Engineer Utilities Zone Clearance SEPA Checklist SPECIAL CONDITIONS: I i; DATE OFFICIAL FEES COLLECTED Single $ Building Plumbing Mech. Plan Check SEPA Mobile Home Other (Specify) dd TOTAL $ 1 PERMIT NUMBER 4 .A1- 9.9..Z."-: DATE >- e — gez) 04* *7..00 *7,00 N 9921g 01=08-80 2 6479. WHEN MACHINE VALIDATED IN THIS SPACE, THIS BECOMES A PERMIT. 01-08-80 992.22 *7.0.0 Q.F- IN ODClrno