1983, 08-17 Permit 83A-7902 ChimneyPLAN NUMBER
APPLICATION/PERMIT
SPOKANE COUNTY — DEPARTMENT OF BUILDING & SAFETY
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
STREET ADDRESS
1.
e . i "7 ? 1 co
PARCEL NO.
LOT
2.
BLOCK
SUBDIVISION
3.
4.
5.
OWNER
PHONE
PHONE
LEGAL DESCRIPTION:
MAILING ADDRESS
t • t 17 I. (v 1?-04c)L A1/
CONTRACTOR
Yr.0
ADDRESS
�•iaWtiE
DESIGNER
LICENSE EXPIRES
ZIP
PHONE
Actual Set Backs In Feet to:
North (South LEast l West
Size of Parcel 1 Zone Classification
Residential ❑
Commercial 0
ZIP
PHONE
Type Const.
Occupancy Spr nklered
❑Yes ❑No ❑Req'd.
New Const. Valuation
Remode ed Valuation
Total Bldg. Floor Area
ADDRESS
ZIP
Main Floor
Upper Floors
Garage/Storage
Greenhouse
6.
CHANGE OF USE FROM
TO
Cover Deck
Uncv. Deck
Fin. Basement
Unfin. Basement
TYPE ONEW ❑ ALT. 0 AD'N. ❑ RPL. ❑ MVE.
%. E BLD.
WORK
0 PLMB. ❑ MECH. ❑ M.H. ❑ POOL
0 OTHER
No. Baths
No. Floors
No. Fin. Rooms
No. Dwellings
Certlfi. of Exempt.
or Variance
Required Yes No❑
Received Yes❑ No❑
Number
8.
9.
DESCRIBE WORK
IAA � �u
VALUATION
CA\tYtiiv y
SOOURCE
F
UTILITIES
GAS
VCjt2 (�Tcx)E
ELECTRIC
WATER
PUBLIC 0
PRIVATE 0
SEWAGE
SEPTIC 0
SEWER 0
Shorelines/Flood Hazard Plans Required ❑
Yes❑ Not Appllc. 0 Received 0
Ownership
Public 0 Private 0
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 au-
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
SIGNATURE OF OWNER OR AGEN 11- u&4Q� DATECAT N t V
SPECIAL APPROVALS SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PRELIM. FINAL DATE
Env. Health
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
PERMIT IS NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
FEES COLLECTED
Building 4.zo`ccD
Plumbing
Mech.
Plan Check
SEPA
Modular/
MFG. Home
Other (Specify)
TOTAL $ 20.
PERMIT NUMBER
S5A - 7G 2_
02* *20.00
790, 1
08-17-83
6.479,
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES AaPERMIT.
DATE ISSUED r 7_ U PERMIT NO.9 0,2
*20,00
TOTAL
3koI
t
70 ANpx -