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1979, 11-06 Permit: M79-7402 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 4 COPIES 1. 2. JQB ADDRESS 7-17.��'t,.�,1'-,��� LOT BLOCK SUBDIVISION Q. LEGAL DESCRIPTION - SEE ATTACHED PARCEL NUMBER/S OWNER 3. _,f ADDRESS 4 Ale) A7 CONTR TOR !�2%' eaiY�&,V 4. 5. PHONE ZIP 7q2 Required Set Backs in Feet North 'South (East 'West PHONE Size of Parcel Zone Classification ADESS DESIGNER ZIP PHONE Type Const. Valuation Occupancy Sprinklered ❑Yes ❑No ❑ Req'd. Building Area in Sq. Ft. ADDRESS ZI P DWL Area Basement Area Garage Area I Storage CHANGE OF USE FROM 6. TO Split Entry Split Level Rancher TYPE 7. OF WORK ❑ NEW ❑ BLD. ❑ ALT. ❑ PLMB. ❑ AD N. ❑ RPL. MECH. ❑ M.H. ❑ MVE. ❑ POOL ❑ OTHER No. Baths No. Floors No. Rooms Rec. Room CERTIFICATE of EXEMPTION Req'd. Rec'd. Not Req'd. DESCRIBE WORK 8. 9 all./ 0 c.e.tGb_ �7 izi VALUATION 9. Source of Utilities AS ELECTRIC WATER SEWER 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 costruction,or the performance of construction. DATE DEPT. //4/7Y SPECIAL APPROVALS REQ'D. REC'D. SIGNATURE Env. Health Planning Fire Marshall Co. Engineer Utilities Zone Clearance SEPA Checklist SPECIAL NDITIONS: //-:;- ! / DATE 1,�GJ U OFFICIAL' (t.L. -vL1 1 FEES COLLECTED Single $ Building Plumbing Mech. Plan Check SEPA Mobile Home Other (Specify) TOTAL $ 7 M DATES/ -4'- '/ PERMIT NUMBER 79-- 741 04* *7.00 *7,00 in - 740,1 2 11-06-79 2 6479, WHEN MACHINE VALIDATED IN THIS SPACE, THIS BECOMES A P RMIT. 11'-06"-79 74Q22 *7,00°�