1982, 11-17 Permit: 82B-1154 Chimney RepairPLAN NUMBER APPLICATION /PERMIT
SPOKANE COUNTY — DEPARTMENT OF BUILDING & SAFETY
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
V APPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 3 COPIES
STREETADDRESS PARCELNO.
�. 6- 11 02� 3*>
LOT I BLOCK I SUBDIVISION LEGAL DE�I)CRIPT!,ON:
PERMIT NUMBER
�-1I1�d-
2. Z
OWNER)'
PHON
PHONE
C�
3.
MAILING ADDRESS
ZIP
Actual Set Backs in Feet to:
North I South East
West
v
CONTRACTOR
LICENSE EXPIRES
P L-
Size of ParcelZone
Classification
Residential
r
G
4.
-
r
Commercial El
ADDRE
P
Type Co st
upancy
Sprinklered
❑Yes ❑No ❑Req'd.
DESIGNER
PHONE
New Const. Valuation
Remodeled Valuation
Total Bldg. Floor Area
5.
1
11_1 i 2
ADDRESS
ZIP
Main Floor Upper
Floors
Garage/Storage
Greenhouse
CHANGE OF USE FROM
TO
Cover Deck
Uncv. Deck
Fin. Basement
Unfin. Basement
6.
No. Baths No.
Floors
No. Fin. Rooms
No. Dwellings
TYPE ❑ ►�gW ALT. ❑ AD'N. ❑ RPL. ❑ MVE.
7. OF El OTHER
WORK BLD. ❑ PLMB. ❑ MECH. ❑ M.H. ❑ POOL
Certifi.ofExempt.
Required
Yes❑ No❑
Number
or Variance
Received
Yes❑ No❑
DESCRI
8•
ORK �V
�r
Shorelines/ Flood Hazard
Plans Required El
Yes Not Applic.❑
Received ❑
VA UATION
SOURCE
GAS
ELECTRIC I
p UBLIAER❑
SEPTIC E
Ownership
FEES COLLECTED
9 0
UTILITIES
PRIVATE ❑
SEWER ❑
Public ❑ Private
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-
a
thority 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
Plumbing
SIGNATURE OF - APPLICATION //
OWNER OR AGENT - DATE 2—
Mech.
SPECIAL APPROVALSi
SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PRELIM. FINAL DATE
Plan Check
Env. Health
Planning
Fire
Prevent.
Utilities
SEPA
Pians PERMIT IS NONTRANSFERABLE
Exam. PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
Building IN 180 DAYS
Tech.
SEPA
Modular/
MFG. Home
Other (Specify)
TOTAL $ w I
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATASSUEj 7 — 8 2 PERMITI1.5. 4 5
*28.00�dJrAL
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W
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