1983, 08-22 Permit: 83A-8025 Chimney PLAN NUMBER APPLICATION/PERMIT PERMIT NUMBER
SPOKANE COUNTY - DEPARTMENT OF BUILDING &SAFETY 83> -E30 -5
CNORTH 811 JEFFERSON /SPOKANE,WASHINGTON 99260/(509)456-3675
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES 0 4. * * 1 4. 0
r
STREET ADDRESS PARCEL NO. * 1 !; 0 0
1. e.,. 4- %(.... Col.."'
LOT BLOCK SUBDIVISION LEGAL DESCRIPTION: R * C' U
2. 302, 4 _`=
OWNER PHONE PHONE
3. E 2 _ C 1-3c c-t �C.ER ��F1;7 0 - 2 2- 3
MAILING ADDRESS ZIP Actual Set Backs in Feet to:
£ • L to Cr`Y' CRC(. -1/4--2_ North 'South East }West b. 4 7 9
CONTRACTOR LICENSE EXPIRES PHONE Size of Parcel Zone Classification Residential❑
4. trA41i1'E - Commercial❑
ADDRESS ZIP Type Const. Occupancy Sprinklered
S,A a DYes ❑No ❑Req'd.
DESIGNER PHONE New Const.Valuation Remodeled Valuation Total Bldg.Floor Area
5. ADDRESS ZIP Main Floor Upper Floors Garage/Storage Greenhouse
CHANGE OF USE FROM TO Cover Deck Uncv.Deck Fin.Basement Unf in.Basement
6.
No.Baths No.Floors No.Fin.Rooms No.Dwellings
TYPE ❑ NEW ❑ ALT. ❑ AD'N. ❑ RPL. ❑ MVE. j
7 WORK ❑ BLD. ❑ PLMB. [ N1ECH. ❑ M.H. El POOL OTHER Certifi.of Exempt. Required Yes No❑ Number
or Variance Received Yes No
DESCRIBE WORK n Shorelines/Flood Hazard Plans Required❑
8. 1 ^-c-t NEC....H t }•4c-f Yes Not Applic.❑ Received ❑
VALUATION SOURCE GAS ELECTRIC WATERPUBLIC❑ SEPTIC❑ Ownership FEES COLLECTED
9. UTILITIES PRIVATE El SEWER El Public El Private El
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 Building
work will be complied with whether specified herein or not. The granting of a permit does not presume to give au-
thority to violate or cancel the provisions of any other state or local law regulating construction or the performance
of construction.SEE REVERSE SIDE FO: REQUI• D INS/RECTIONS Plumbing
SIGNATURE OF --' f 1f/ .16— DATEAPPLI _3� Mach. ��`
OWNER OR AGE .saiR
SPECIAL APPROVALS SPECIAL CONDITIONS. : E REVERSE SIDE FOR NOTICE)
PRELIM. FINAL DATE Plan Check
Env.Health
SEPA
Planning
Modular/
Fire MFG.Home y.
n.
Prevent. o
O
o
Engineer
Other(Specify) LY
J_
Utilities LT_
TOTAL $ 14-00
SEPA
WPlans EN MACHINE
PERMIT IS NONTRANSFERABLE THFIS BECOMES A PERM TTED IN THIS SPACE,
Exam. PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
Building 9 ?j-
IN 180 DAYS (� 2 -8 3 2 5 z 14 0 0 DAT .S...- PERMITYJO. * '34
Tech.