1981, 12-28 Permit G81B-2899 Flue DampersPLAN NUMBER
APPLICATION/PERMIT
SPOKANE COUNTY — BUILDING CODES DEPARTMENT
PERMIT NUMBER
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 3 COPIES
1.
2.
3
JOB ADDRESS
5-tyro e/
LOT BLOCK
/✓e /t- /Lo/
SUt3UIVISIUN
OWNER
CG a ft y U 1/ eitAt
ADDRESS
Sr 5 oa €/ I`i R/
CONTRACTOR
�8`/f9 dull /� hr�� f £%c
4' ADDRESS
e- 4 7 r O l zre/.
DESIGNER
ADDRESS
CHANGE OF USE FROM
6.
TYPE
7, OF
WORK
❑ NEW
❑ BLD.
❑ ALT.
❑ PLMB.
PHONE
Y.tsr-oY�r3
ZIP
79,x0 6
PHONE
gat 4 - ,A/UC/
ZIP
PHONE
ZIP
TO
❑ AD N.
❑ MECH.
❑ RPL.
❑ M.H.
❑ MVE.
❑ POOL
0 OTHER
LEGAL DESCRIPTION - SEE ATTACHED
PARCEL NUMBER'S
Actual Set Backs in Feet
North (South East 'West
Size of Parcel
Type Const.
Zone Classification
Occupancy Sprinklered
Oyes ❑No ❑ Req'd.
Valuation Building Area in Sq. Ft.
Main Floor Upper Floors Garage Area Storage
Area of Decks
Finished Basement
Unfin. Basement
No. Baths
No. Stories No. Rooms No. of Dwellings
CERTIFICATE
of EXEMPTION
Req'd. Rec'd.
DESCRIBE WORK
8. f vslyre%/ f/wf'
VALUATION SOURCE ! GAS
OF
9. UTILITIES
u/teZt' G4tr0A ///ti•leg
ELECTRIC
WATER
SEWER
Enum, Dist,
Location (Area)
Ownership
Public 0 Private ❑
USE CODE
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 rQ —/7 - h/ SIGNATURE OF APPLICANT
SPECIAL APFIROVALS
NAME DATE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
SPECIAL CONDITIONS:
// f /i '1aGty�t' ii
Not Req'd.
FEES COLLECTED
Single $
Building
Plumbing
Mech.
/
Plan Check
/0,on
SEPA
Mobile Home
Other (Specify)
TOTAL
04* * 1 9.00
* 1 9,00 N
* 1 9,006
A *0,00
289.82
12-21-81
z 6479,
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
`. t ' ; 28'.9,'9Z, *19,00 �:_
11-13.1
DATE ISSUED f ° PERMIT NO. TOTAL