1980, 12-16 Permit: 80B-4890 Fireplace InsertPLAN NUMBER
APPLICATION/PERMIT
SPOKANE COUNTY — BUILDING CODES DEPARTMENT
NORTH B11 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 3 COPIES
JOB ADDRESS
g6) -//e y 7/007N
LOT BLOCK SUBDIVI ION
LEGAL Q►ESCRJPTION - SEE ATTACHED
OW
3. .r�C.L
ADESS
E.2769 i / �,
CONTRJgCTOR /4 `
E S X?,a. T710-
4..L2
41ES:78 <_3 "70 7
IGNER
4,57 „Wd97
PARCEL NUMBER/S
Actual Set Backs in Feet
South East
North
Wes
a
PHONE? , - 701_,
"1" 7c
Size of Parcel
Zone Classification
5. ADDRESS
Z 9,U
Type Const.
Occupancy
Sprinklered
Elves ❑No ❑ Req'd.
PHONE
Valuation
Building Area in Sq. Ft.
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
`51. NEW
❑ BLD.
El ALT.
❑ PLMB.
❑ AD'N.
❑ RPL.
ECH. ❑ M.H.
❑ MVE.
❑ POOL
❑ OTHER
No. Baths
No. Stories
No. Rooms
No. of Dwellings
CERTIFICATE
of EXEMPTION
Req'd.
Rec'd.
Not Req'd.
DESCRIBE WORK
VALUATION
9.
SOURCE
OF
UTILITIES
GAS
zr_1l//j ,i LL. -f
ELECTRIC WATER SEWER
Enum. Dist. I Location (Area)
Ownership
Public ❑ Private ❑
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 I regulating construction or the
Srmance
of construction. SEE REVERSE SIDE FOR REQUIRED INSPECT! S
DATE OF APPLICATION
SPECIAL APPROVALS
NAME DATE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
ingTeian
SIGNATURE OF APPLICAN
SPECIAL CONDITIONS:
PERMIT IS NONTRANSFERABLE
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL
7 cv
r/
PERMIT NUMBER
g0 3
04* *7,00
*7.00 N
*7.00e
A *0.00
4889
12-16-80
z 6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
12-16-190
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE DATE ISSUED
489,02
PERMIT NO.
*%00°a1-1
TOTAL