1980, 11-10 Permit: 80B-3547 FireplacePLAN NUMBER
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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
1.
3
4.
JOB I ADDRESS
K ' OOP lJI
LOT ✓ BUCK SUBDIVISION
Ili, Jor1 /6., 19 p1-_ ot\I
OWNER
GSM h
ADDIRESS 9 I
NLAOO u.N\I
��
ADDRESS
LEGAL DESCRIPTION - SEE ATTACHED
PARCEL NUMBER/S i 714 z 74-
Actual Set Backs in Feet
'South
North
East
'West
PHONE
ZIP
Size of Parcel Zon Classificatio
Type Const.
Occupancy
Sprin)flered
Elves ❑No ❑ Req'd.
DESIGNER
PHONE
Valuation
Building Area in Sq. Ft.
ADDRESS
ZI P
Main Floor
Upper Floors
Garage Area
Storage
CHANGE OF USE FROM
6.
TO
Area of Decks
Finished Basement
Un in. Basement
TYPE
7. OF
WORK
D N W ❑ ALT. EAD'N. ❑ RPL. ❑ MVE.
D. ❑ PLMB. ❑ MECH. ❑ M.H. ❑ POOL
❑ OTHER
No. Baths
No. Stories
No. Rooms
No. of Dwellings
CERTIFICATE
of EXEMPTION
Req'd.
Rec'd.
Not sati'd.
8.
DESC;a WORK
OK
VALUATION
9. 9 00
SOURCE
OF
UTILITIES
0-1
GAS
ELECTRIC
WATER
SEWE R
Enum. Dist. I Location (Area)
Ownership .l,VIJSE CODE
Public El Private u
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 // 7! / — //(/4 0 SIGNATURE OF APPLICANT
SPECIAL APPROVALS
NAME DATE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
SPECIAL CONDITIONS:
PERMIT IS NONTRANSFERABLE
FEES COLLECTED
Single $
Building I 2.
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL $
PERMIT NUMBER
0 - $4.7
02* *1600
*1600
*16006
A *0.00
354,6
11-10-80
6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
}}},}(}.L80 3,5478 *16.00ap' -
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE DATE ISSUED PERMIT NO. TOTAL