1980, 05-27 Permit: 80-5040 Fireplace InsertPLAN 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
JOB ADDRESS
1. \\•iZ\ t \8TIh
LOT BLOCK SUBDIVISION
2.
OWNER
3. 20 t.4 r4-
ADDRESS
1 7z i e . iB-rl-t,
G�sN
PHONE
c‘z4c,- v9RS
LEGAL DESCRIPTION - SEE ATTACHED
PARCEL NUMBER/S
ZIP
Crt zap
Actual Set Backs in Feet
North (South East (West
4.
CONTRACTOR
ADDRESS
PHONE
Size of Parcel 1 Zone Classification
ZIP
Type Const.
Occupancy
Sprinklered
Oyes ❑No ❑ Req'd.
DESIGNER
5' ADDRESS
PHONE
Valuation )Building Area in Sq. Ft.
ZIP
Main Floor
Upper Floors 1 Garage Area
Storage
CHANGE OF USE FROM
6.
TYPE
7. OF
WORK
TO
Area of Decks
Finished Basement
Unfin. Basement
VrNEW ❑ ALT. ❑ AD'N. ❑ RPL. ❑ MVE.
❑ BLD. 0 PLMB. 2I/MECH. ❑ M.H. ❑ POOL
0 OTHER
No. Baths
No. Stories
No. Rooms
No. of Dwellings
CERTIFICATE
of EXEMPTION
Req'd.
Rec'd.
Not Req'd.
DESCRIBE WORK
a. Ftp r'c_ cC 1 n.1SE.2.
Enum. Dist.
ILocation (Area)
VALUATION
9.
SOURCE
OF
UTILITIES
GAS
ELECTRIC
WATER
SEWER
Ownership
Public ❑ 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 INSPECTIOI,V&
DATE OF APPLICATION 1J 0 SIGNATURE OF APPLICANT
/) c../eL
SPECIAL APPROVALS
NAME DATE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
Buildigg Technician
S . 6/z 7J 9
SPECIAL CONDITIONS:
PERMIT IS NONTRANSFERABLE
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL
$ cs.
PERMIT NUMBER
'ESC) -- so 4a
04* *7.00
*7,00
50398
05-27-80
6479,
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
ti'5727'y8'0 504,05
CL
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE *DATE ISSUED PERMIT NO. TOTAL