1984, 01-16 Permit: 84A-417 Fireplace InsertPLAN 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
ST EET ADDRESS
1. oral
l
LOT BLOCK
2.
OWNER
3. 1 j I C_L nr i
1_,(i_aAier
SUBDIVISION
ILING ADDREfS
G i -_I e MI ] Ec rPn 7S
PHONE
1.6 - - q4c) G�
4.
CONTRACTOR
ADDRESS
LICENSE EXPIRES
DESIGNER
5.
ADDRESS
6.
CHANGE OF USE FROM
PHONE
ZIP
PHONE
ZIP
TO
TYPE ❑ NEW ❑ ALT. ❑ AO'N. ❑ RPL. ❑ MVE.
7. OF WORK ❑ BLD. ❑ PLMB. EMECH. ❑ M.H. ❑ POOL ❑ OTHER
PARCEL NO.
LEGAL DESCRIPTION:
Actual Set Backs In Feet to:
North South
Sizeof Parcel
Type Const.
Occupancy
New Const. Valuation
Main Floor
East
West
Zone Classification
Residential ❑
Commercial fJ
Spr nklered
❑Yes ❑No ❑Req'd.
Remode ed Valuation
Upper Floors Garage/Storage
Cover Deck
No. Baths
Certifi. of Exempt.
or Variance
Total Bldg. Floor Area
Uncv. Deck
No. Floors
Fin. Basement
Greenhouse
No. Fin. Rooms
Required YesD No
Received Yes No ^
DF CRIBE WORK
S. � ' +D C'k(' r Z k 5 -Le 1`
GAS
VALUATION SOURCE
9FLI
UTILITIES
ELECTRIC
WATER
PUBLIC ❑
PRIVATE 0
SEWAGE
SEPTIC 0
SEWER 0
Shorelines/Flood Hazard
Yes Not Applic. ❑
Ownership
Public 0 Private 0
1 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 . (l;! u�+1 )r� 1-07li ,�,{ DATLICATION,
OWNER OR AGENT
DATE i.a- `��
SPECIAL APPROVALS
PRELIM FINAL DATE
Env. Health
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PERMIT IS NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
Unf in. Basement
No. Dwellings
Number
Plans Required
Received 0
FEES COLLECTED
Building
Plumbing
Mech.
Plan Check
SEPA
Modular/
MFG. Home
Other (Specify)
.6112
TOTAL $ '
PERMIT NUMBER
4A --1(7
04* *20.00
*2000Y
A *000 0
41.62
01-16-84
6479.
O-
O
C.,
W
—J
LA—
WHEN
L
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATE`1SLED1 6-S 4 PERMIT N. 1. 7
*20.0 O *CtTAL