1980, 11-24 Permit: 80B-4146 ChimneyPLAN NUMBER
APPLICATION/PERMIT
SPOKANE COUNTY — BUILDING CODES DEPARTMENT
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
e//
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
1.
2.
3
JO,ADDRESS
LOT
171
%%/ 12
BLOCK
SUBDIVISION
M I rr�jVa
OWNER
J ;AI
ADDRESS
//�/2
PHONE
�?a. L./467
ZIP
LEGAL DESCRIPTION — SEE ATTACHED
PARCEL NUMBER/S
o•� 94,2..
— 1 A �I
Actual Set Backs in Feet
North (South
East 'West
CONTRACTOR
4Pk/9 PkAhete s Cl. hr), ln�?
ADDRESS
Rta6vy9 S®)kAnf' WAsl-
DESIGNER
5. ADDRESS
PHONE
-sy 1 c
ZIP
9920 '7
PHONE
Size of Parcel 1 Zone Classification
Type Const.
Occupancy
Sprinklered
❑Yes ❑No ❑ Req'd.
Valuation Building Area in Sq. Ft.
ZIP
Main Floor
Upper Floors 1 Garage Area
Storage
CHANGE OF USE FROM
6.
TO
Area of Decks
Finished Basement
Unfin_ Basement
TYPE
7. OF
WORK
4tWEW
BLD.
❑ ALT.
❑ PLMB.
[e-AD'N.
❑ MECH.
❑ RPL. 0 MVE.
0 OTHER
❑ M.H. 0 POOL
No. Baths
No. Stories
No. Rooms
No. of Dwellings
CERTIFICATE
of EXEMPTION
Req'd.
Rec'd.
Not Req'd.
DESCRIBE WORK �1
8. 1 (-LJ (/i Oil ,rt t, te,,/ L /-id AX -e0 01/...01-11-4-4)
SEWER
VALUATION
9.
SOURCE
OF
UTILITIES
GAS
ELECTRIC
WATER
Enum. Dist.
Location (Area)
Ownership
Public ❑ Private ❑
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 INSPECTIONS
DATE OF APPLICATION 1/— !X � /J e
SIGNATURE OF APPLICA %CLd 4wE 1 J Maf3��i
SPECIAL APPROVALS
NAME DATE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
an
SPECIAL CONDITIONS:
PERMIT IS NONTRANSFERABLE
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify) /il, It)
TOTAL
PERMIT NUMBER
-- 41;*<
02* *1000
* 10.00 '()
* 10.006
A *0.00
411.2
11-24-80
6.479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
i1-24-8
4146
*1Q00a�
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE DATE ISSUED PERMIT NO. TOTAL