1983, 10-21 Permit: 83B-737 FireplacePLAN 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
LOT
2.
BLOCK
SUBDIVISION
PARCEL NO.
LEGAL DESCRIPTION:
OWNER
3. T1M Ikv
MAILING ADDRESS
CONA fR
4.
ADDRESS
PHONE
PHONE
ZIP
Actual Set Backs in Feet to:
North (South
East
West
LICENSE EXPIRES
PHONE
Size of Parcel
Zone Classification
Residential ❑
Commercial ❑
ZIP
Type Const.
Occupancy
Spr'nklered
❑Yes No ERN 'd.
DESIGNER
PHONE
New Const. Valuation
Remodeled Valuation
Total Bldg. Floor Area
ADDRESS
ZIP
Main Floor
Upper Floors
Garage /Storage
Greenhouse
CHANGE OF USE FROM
TO
Cover Deck
Uncv. Deck
Fin. Basement
Unfin. Basement
TYPE EW ❑ ALT. N. ❑ RPL. ❑ MVE.
7. OF ❑ OTHER
WORK ❑ BLD. ❑ PLMB. MECH. ❑ M.H. ❑ POOL
No. Baths
No. Floors
No. Fin. Rooms
No. Dwellings
Certif1. of Exempt.
or Variance
Required Yes❑ No
Received Yes❑ No❑
Number
DESCRIBE C-' G��� /. NI , f c
SOURCE GAS ELECTRIC 'V V'1
VALUATION
9.
WATER
OF PUBLIC ❑
UTILITIES PRIVATE ❑
Shorelines /Flood Hazard
Yes❑ NotApplic. ❑
Plans Required
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 FOR RE • UIRED INSPECTIONS
SIGNATURE OF
OWNER OR AGENT
SPECIAL APPROVALS
PRELIM. FINAL DATE
APPLICATION
DATE a yG
�S' ECIAAd ONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
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
Plumbing
Mech.
Plan Check
SEPA
Modular/
MFG. Home
Other (Specify)
TOTAL $
PERMIT NUMBER
7777
7
04* *3000
7362
10 -21 -83
6479
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATE IS, UEC 1 U 3
PERMIT N.J. � 7 o
* 3 0 g3iIAL