1983, 12-19 Permit: 83B-2628 Inserti
PLAN 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. 8701 Boone
PARCEL NO.
LOT
2.
BLOCK
SUBDIVISION
3
4.
5.
OWNER
Mrs. Backlund
MAILING ADDRESS
E. 8701 E. Boone
CONTRACTOR
Valley Fireplace
ADDRESS
E. 16610 Sprague Ave.
PHONE
924-0850
Spokane, WA
LICEN E XPIRES
1/1/84
Veradale, WDA
DESIGNER
Contr. License ; VALT.EF-177CG
ADDRESS
CHANGE OF USE FROM
6.
PHONE
ZIP
99212
PHONE
922-2780
ZIP
99037
PHONE
ZIP
TO
TYPE ,O'NEW ❑ ALT. ❑ AD' N. ❑ RPL. ❑ MVE.
7. OF OTHER
WORK ❑ BLD. ❑ PLMB./MECH. ❑ M.H. ❑ POOL
LEGAL DESCRIPTION:
Actual Set Backs in Feet to:
North ISouth
Size of Parcel
East West
Zone Classification
Type Const.
Occupancy
Residential ❑
Commercial ❑
Sprinklered
EYes ❑No Req 'd.
New Const. Valuation
Main Floor
Cover Deck
Remodeled Valuation
Total Bldg. Floor Area
Upper Floors
Garage/Storage
Uncv. Deck
Fin. Basement
Greenhouse
Unfin. Basement
No. Baths
No. Floors
No. Fin. Rooms
No. Dwellings
Certifi. of Exempt.
or Variance
Required
Received
YesE No❑
Yes Nof7
DESCRIBE WORK Lnstallation of 0_o�n�}v ctor
8. into IC Fireplace. fGj••n,'u
VALUATION SOURCE GA� ELECTRI WATER
PUBLIC ❑
9•
UTILITIES F PRIVATE ❑
Insert
SEWAGE
SEPTIC ❑
SEWER ❑
Shorelines/ Flood Hazard
Yes ❑ Not Applic. ❑
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 pro isions of any other state or local law regulating construction or the performance
of construction. SEE REVERSE I E FOR REQUIR INS ECTIONS
SIGNATURE OF
OWNER OR AGENT ( IC? J -A.4432.
/l1(C�' DATE
APPLICATION
-g
SPECII L APPROVALS SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PPIELIM. FINAL DATE
Env. Healtr
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
g/PI
PERMIT IS NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
Number
Plans Required E
Received ❑
FEES COLLECTED
Building
Plumbing
°�
Mech.
Plan Check
SEPA
Modular/
MFG. Horne
Other (Specify)
TOTAL $ 2O1
PERMIT NUMBER
0'313-` '
04*
*20.00
*20.006
*0,00
`62,7-2
12-19-83
6479.
FII F f'f1PY
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
1 `� y:
DATE tIED1 9 8 3
PERMIT NO: 2. 8 z
*2 0.0 0144=',a.