1981, 10-22 Permit: 81B-970 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 3 COPIES
OB ADDRESS
1. //6o r7
(ill n e s e_
LOT SUBDIVISION
2.
O ER f/��
3. lC l�r���
ADDRESS
A//e.?a7 Suy,/rNiv
CONTRACTO5j
4,%f /i5A/I f I'24 / Q i e FA R/17 S e lLd/a M ask
BLOCK
DRESS
DESIGNER
5. ADDRESS
LEGAL DESCRIPTION — SEE ATTACHED
PARCEL NUMBER/S
PHONE
.93131- 7
ZIP
99a 4,
Actual Set Backs in Feet
North (South East 'West
PHONE
del sy7(
Size of Parcel 1 Zone Classification
ZIP
4.2X7
Type Const.
Occupancy
Sprinklered
❑Yes ❑No 0 Req'd.
PHONE
Valuation (Building Area in Sq. Ft.
ZIP
Main Floor
Upper Floors 1 Garage Area
Storage
CHANGE OF USE FROM
6.
TO
Area of Decks
Finished Basement
Unfin. Basement
TYPE
7. OF
WORK
❑ NEW 0 ALT. 0 AD'N. 0 RPL. 0 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.
8.
9.
D CRIBE WORK
pp,' A
VALUATION C
OURCE
OF
UTILITIES
GAS
ELECTRI
WATER
SEWER
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 INSPECTIONS
DATE OF APPLICATION /G" /C t , SIGNATURE OF APPLICANT
SPECIAL APPROVALS
NAME DATE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
ding Te clan J� r
SPECIAL CONDITIONS:
PERMIT IS NONTRANSFERABLE
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL $ /740
r5O
1(1
PERMIT NUMBER
27O
G4* *170C
,l700
*1700Y
rl *0 nJO
1 —22-01
6479,
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
-8;r11
97,0 z
*17.00 a