1982, 10-25 Permit: 82B-0064 FireplacePLAN 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.
3.
OB ADDRESS
/441-74.) — /,f•7X
L Alp C74 /E'
LOT
BLOCK
SUBDIVISION
L%f 9 3
LEGAL DESCRIPTION - SEE ATTACHED
OWNER
v.S � c 7/ ////9 77`
P ONE
PARCEL NUMBER/S
ADDRESS /4/ 4.) -- J iii 1L,e c/4/{
CONTRACTOR
4- ADDRESS
ZIP
(7'go91
Required Set Backs in Feet
North 'South [East (West
PHONE
- t
Size of Parcel 1 Zone Classification
ZIP
Type Const.
Occupancy
Sprinklered
❑Yes ❑No ❑ Req'd.
DESIGNER
5. ADDRESS
PHONE
Valuation 1Building Area in Sq. Ft.
ZIP
DWL Area I Basement Area Garage Area
Storage
CHANGE OF USE FROM
6.
TYPE
7. OF
WORK
TO
Split Entry
Split Level
Rancher
NEW
❑ BLD.
❑ ALT. ❑ AD N. ❑ RPL. ❑ MVE.
❑ PLMB. XMECH: ❑ M.H. ❑ POOL
E OTHER
No. Baths No. Floors No. Rooms
CERTIFICATE Req'd.
of EXEMPTION
Rec. Room
Rec'd.
Not Req'd.
8. DESgAIIIE CWO R K
G:
9.
VALUATION 1
Source
of
Utilities
GAS
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 constr ction or the
performance of constrfuction.))i
DATE /O • Carl / r l> SIGNATURE
DEPT_
SPECIAL APPROVALS
REQ'D. RECD.
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Zone Clearance
SEPA Checklist
SPECIAL CONDITIONS:
DATE/a/OFFICIAL��
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL $ liO.' a
PERMIT NUMBER
DATE
04*
A
*20.00
*20,008
*0.00
63R
10-25-82
2 6479,
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BI�CO ES A POE�tMIT. 6.45 *2
0.0
0 a