1982, 10-06 Permit 82A-9134 ChimneyPLAN 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
3.
JOB ADDRESS
LpT BLOCK SUBDIVISION � Vb ( � po9
OWNER
ADDRESS
�✓ - 4;moo
CONTR CTO. (�
ADDRESS
DESIGNER
5' ADDRESS
CHANGE OF USE FROM
6.
TYPE
7, OF
WORK
0 NEW
0 ALT.
BLD. 0 PLMB.
DESCRIBE WORK
8.
N �
9.
VALU TON SOU CE
OF
UTILITIES
1r
PHONE
ZIP
PHONE
ZIP
TO
ErAD N.
0 MECH.
E- I
GAS
❑ RPL.
❑ M.H.
ELECTRIC
❑ MVE.
❑ OTHER
0 POOL
WATER
SEWER
LEGAL DESCRIPTION — SEE ATTACHED
PARCEL. NUMBER/S
Actual Set Backs In Feet
North 'South
Size of Parcel
^ I I o�i--
East 'West
Zone Classification
Type fo st.
O-zctipancy
Valuation
Sprinklered
❑Yes ❑No 0 Req'd.
Building Area in Sq. Ft.
Main Floor Upper Floors
Garage Area
Area of Decks
Finished Basement
No. Baths
No. Stories
Storage
Unfln. Basement
No. Rooms
No. of Dwellings
CERTIFICATE
of EXEMPTION
Enum. Dist.
Location (Area)
Ownership SE CODE
Public ❑ Private
Req'd. Rec'd.
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��" k—eg
SIGNATURE OF APPLICANT,
SPECIAL APPROVALS
NAME DATE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
SPECIAL CONDITIONS:
Not Red
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL $ ?:-~0
_
02* *20.00
*20.006
A *0,00
913.32
10-06-82
2 6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
Buil Te?i
n
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
/&-].4i 0 6'-8 2. 9'13.4'z * 2 0, 0 O a �. -
' DATE ISSUED PERMIT NO. TOTAL