1980, 09-26 Permit: 80B-966 ChimneyPLAN NUMBER APPLICATION/ PERMIT
PERMIT NUMBER
I &3—q&1>
SPOKANE COUNTY — BUILDING CODES DEPARTMENT
NORTH 811 JEFFERSON / SPOKANE; WASHI'JGTON 99260 / (509) 456-3675
DATE 9/24/80
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 4 COPIES
* 1 2 5 0
* 1 2 5 0 N
JOB ADDRESS
12909 E. 28th
LEGAL DESCRIPTION —SEE ATTACHED
�
* 1 2.5 0
LOT
BLOCK
SUBDIVISION
PARCEL NUMBER/S
2.
A .* 0.00 v
OWNER
PHONE
3. J. R. Russell
928-7875
9652
ADDRESS
ZIP
Required Set Backs in Feet
12909 E. 28th Ave.
09=26-80
North south Eastwest
6479,
CONTRACTOR
PHONE
Size of Parcel
Zone Classification
Valley Fireplace,, Inc.
922-2780
4. ADDRESS
ZIP
Type Const.
Occupancy
Sprinklered
E. 16610 Sprague Ave.
99037
❑Yes ❑No ❑ Req'd.
DESIGNER ! •
PHONE
Valuation
Building Area in Sq. Ft.
Contractor Specialty
5.
ADDRESS
No. VA LL EF 526 O'v_N
ZIP
DWL Area
Basement Area
Garage Area
Storage
CHANGE OF USE FROM
TO
Split Entry
Split Level
Rancher
6.
TYPE ❑ NEW El ALT. ❑ AD'N. El RPL. ❑ MVE.
No. Baths
No. Floors
No. Rooms
Rec. Room
7, OF 2 OTHER
CERTIFICATE Req'd.
Recd.
Not Req'd.
El BLD. 11PLMB. ElMECH: ElM.H. El POOL
WORK
of EXEMPTION
DESCRIBE WORK
g. install prefabricated insula.t6d chimney FEES COLLECTED
VALUATION
Source
GAS
ELECTRIC
WATER
9.
of
utilities
Single $
I hereby certify that I have read and examined this application and have read the "NOTICE" pro
on reverse side, and know the same to be true and correct. All provisions of laws and ordinances Building
]presume
type of work will be complied with whether specified herein or not. The granting of a permit deto
give authority to violate or cancel the provisions of any other state or local I w regulatin con%eperformaanceof
Plumbing
construction.
DATE / SIGNATUREMech.
aC
SPECIAL APPROVALS SPECIAL CONDITIONS:
DEPT. REQ -D. RECD. ' Plan Check
Env. Health
Ready for inspection
o
SEPA
C
H
Planning
G
— v
n
Mobile Home
Fire Marshall
C,
�
Co. Engineer Other (Specify)
Utilities Q
/ 2
TOTAL $
Zone Clearance
WHEN MACHINE VALIDATED
IN THIS SPACE,
SEPA Checklist G�._.,2�. — ff l% THIS BECOMES A PERMIT.
.. n
.I
DATE OFFICIAL L47i7/�it��-