1982, 06-21 Permit: 82A-5134 InsertPLAN NUMBER
APPLICATION/PERMIT
SPOKANE COUNTY - BUILDING CODES DEPARTMENT
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 3 COPIES
JOB ADDRESS
S. 1605 Bolivar
LEGAL DESCRIPTION - SEE ATTACHED
LOT
BLOCK
SUBDIVISION
OWNER
3. --;:1.111 m). Orr
PHONE
922-063
PARCEL NUMBER/S
ADDRESS
C. 1605 Bolivar Veradale
ZIP Actual Set Backs in Feet
99037 North (South East ]West
HONE
922-2780
4.
CONTRACTOR
Valley Fireplace, Inc.
P
Size of Parcel
Zone Classification
ADDRESS
16610 Snravie Ave_ Verndnle
DESIGNER
::Ltractor License)No. VAaEF 626
ZIP
Type Const.
Occupancy
Sprinklered
❑Yes ❑Na ❑ Req'd.
PHONE
Valuation Building Area in Sq. Ft.
ADDRESS
ZIP
Main Floor
Upper Floors
Garage Area
Storage
CHANGE OF USE FROM
6.
TYPE
7. OF
WORK
TO
Area of Decks
Finished Basement
Unfin. Basement
❑ NEW
❑ BLD.
❑ ALT.
❑ PLMB.
❑ AD'N.
❑ MECH.
❑ RPL.
❑ M.H.
❑ MVE.
❑ POOL
❑ OTHER
No. Baths
No. Stories
No. Rooms
No. of Dwellings
CERTIFICATE
of EXEMPTION
Req'd.
Rec'd.
Not Req'd.
DESCRIBE WORK
8.•
VALUATION
9.
Install Blaze .Princess Fireplace Insert
r>asonry x'= ELECTRIC WATER SEWER
OF
UTILITIES
Enum. Dist.
Location (Area)
Ownership
Public ❑ Private 0
USE CODE
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 INSPECTION
DATE OF APPLICATION
SPECIAL APPROVALS
NAME DATE
Env. Health
Planning
Fire Marshall
Co. Enginee
Utilities
Plans Examiner
SEPA Checklist
Bu y,W ing,T.echnician
SIGNATURE OF APPLICANT
SPECIAL CONDITIONS:
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
FEES COLLECTED
Single $
Building
Pjumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL $ c'
PERMIT NUMBER
04* *20.00
*20.006
A *0.00 0
513.32
06-21-82
2 6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
0;6'-2 I -8 2
513.42 *20.00°�
DATE ISSUED PERMIT NO.