1980, 10-28 Permit M80B-2522 FireplacePLAN NUMBER
APPLICATION/PERMIT
SPOKANE COUNTY - BUILDING CODES DEPARTMENT
PERMIT NUMBER
/`' d13— 2�
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 3 COPIES
JOB ADDRESS
1:1
LO BLOCK'ar SUBDI 171
2.
OWNER,
ADD ESS
ACTOR
/✓y iI
4' ADDRESS
DESIGNER
3.
LEGAL DESCRIPTION - SEE ATTACHED
5. ADDRESS
PHONE
y a-`z i;s;..
ZIP
PHONE
PARCEL NUMBER/S
Actual Set Backs in Feet
North (South
Size of Parcel
[East
'West
Zone Classification
ZI P
Type Const.
Occupancy
Sprinklered
❑Yes ❑No ❑ Req'd.
PHONE
ZIP
Valuation
Main Floor I Upper Floors
Building Area in Sq. Ft.
Garage Area
Storage
CHANGE OF USE FROM
6.
TO
Area of Decks
Finished Basement
Unfin_ Basement
TYPE
7. OF
WORK
❑ NEW
❑ BLD.
❑ ALT.
❑ PLMB.
❑ AD'N.
3 MECH.
❑ RPL.
D M.H.
❑ MVE.
❑ POOL
DESCRIBE WORK
8. 12, 3 g""""``t—
VA�N WATER
9.
SO( tCE GAS I ELECTRIC
OF
UTILITIES
❑ OTHER
SEWER
No. Baths
No. Stories
No. Rooms
No. of Dwellings
CERTIFICATE
of EXEMPTION
Enum. Dist. I Location (Area)
Ownership
Public ❑ Private ❑
USE CODE
Req'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 /‘:17 SIGNATURE OF APPLICANT
SPECIAL APPROVALS
NAME DATE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
SPECIAL CONDITIONS:
Rec'd.
Not Rec'd.
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL
/7-0-
04* *7.00
*7.00 17)
*7.006
A *000 8
252.1 z
10-23-80
6479.
k
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
L
L
Xding�ci��f
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
`10 r42:'51
DATE ISSUED
252,2(
PERMIT NO.
*7,D 0 °�
TOTAL