1983, 11-28 Permit: 83B-2038 Fireplace W/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.
LOT
2.
BLOCK
z
ce_ Cwt L
SUBDIV SI N
PARCEL NO.
/AJER
'3 tZiV\
MAILING ADDRESS
17501 A11Ct.
P ONE
PHONE
LEGAL DESCRIPTION:
Actual Set Backs in Feet to:
North 'South East I West
C RACT R
4. (lie\o
ADDRESS
DESIGNER
5.
LICENSE xPJRES
o 7
PHONE
Size of Parcel
Zone Classification
Residential ❑
Commercial ❑
Type Const.
Occupancy
New Const. Valuation
Sprinklered
❑Yes ❑No ❑Req'd.
Rernode ed Valuation
Total Bldg. Moor Area
ADDRESS
ZIP
Main Floor
Upper Floors
Garage /Storage
Greenhouse
CHANGE OF USE FROM
6.
TO
Cover Deck
Uncv. Deck
Fin. Basement
Unfin. Basement
TYPE 2141EW ❑ ALT. ❑ AD' N. ❑ RPL. ❑ MVE.
7. WORK ❑ BLD. ❑ PLMB. 2/MECH. ❑ M.H. ❑ POOL E] OTHER
No. Baths
No. Floors
No. Fin. Rooms
No. Dwellings
Cert ifi. of Exempt.
or Variance
Required Yes❑ No
Received Yes ID No❑
Number
DESCRIB WO
8. it, t.
VALUATION
9.
SOURC
F
UTILITIES
GAS
ELECT IC
c
W TER
PU IC ❑
PRIV E ❑
V \L% .t
Shorelines /Flood Hazard
Yes Not Applic. ❑
Plans Required LI
Received ❑
SEWAGE '
SEPTIC ❑
SEWER ❑
Ownership
Public ❑ Private ❑
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 FO ► IRE ' INSPECTIONS
SIGNATURE OF
OWNER OR AGENT
SPECIAL APPROVALS
PRELIM. FINAL DATE
Env. Health
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
SPECIA CONDITI
DATE APPLICATION )
: (SEE REVERSE SIDE FOR NOTICE)
PERMIT IS NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
FEES COLLECTED
Building
Plumbing
Mech.
Plan Check
SEPA
Modular/
MFG. Home
Other (Specify)
TOTAL $
PERMIT NUMBER
0(A* *20.00
*20006
A *0.00
203,72
11 -28 -83
2679.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
p
DATE ISSUED 2 8 — 8 3
PERMI12N 8 z
* 2 O. 0 0 pdrAL