1983, 11-29 Permit: 83B-2107 FireplacePLAN NUMBER
APPLICATION / F'LKIVI I 1
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 B LOCK 1
2.
3.
4.
OWNER
((!
SUBDIVISION
MAILING ADDRESS ��}}
3 i 13 ! 61-e-/ L )
CONTRACTOR /
PHONE
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LICENSE EXPIRES
PHONE
ZIP
ADDRESS ), , 13 37°7
DESIGNER
5.
ADDRESS
CHANGE OF USE FROM
PHONE
ZIP
TO
TYPE ❑ NEW ❑ ALT. ❑ AD' N. ❑ RPL. ❑ MVE.
7. OF ElOTHER
WORK ❑ BLD. El PLMB. 'EK1ECH. ❑ M.H. E7POOL
DESCRIBE WORK
VALUATION
9.
)1 tLa- btee 71e/Le.-
WATER WATER
PUBLIC 0
PRIVATE 0
SOURCE
UTILITIES
GAS
ELECTRIC
SEWAGE
SEPTIC 0
SEWER 0
PARCEL NO.
LEGAL DESCRIPTION:
Actual Set Backs in Feet to:
North
South East
Size of Parcel
Type Const.
New Const. Valuation
Cover Deck
No. Baths
West
Zone Classification
Residential ❑
Commercial ❑
Spr'nklered
❑Yes 0 N Req 'd.
Remodeled Valuation
Uncv. Deck
No. Floors
Total Bldg. Floor Area
Greenhouse
Fin. Basement
No. Fin. Rooms
Required Yes❑ No❑
Received Yes❑ No T1
Shorelines/Flood Hazard
Yes ❑ Not Applic. ❑
Ownership
Public 0 Private 0
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 EQUIRED INSPECTIONS
SIGNATURE OF �� J fi , L /3/ I DATE APPLICATION /_
OWNER OR AGENT _ �-C
Unfin. Basement
No. Dwellings
Number
Plans Required 0
Received 0
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
FEES COLLECTED
Building
Plumbing
Mech.
Plan Check
SEPA
Modular/
MFG. Home
Other (Specify)
TOTAL $64Y-1
rIVII I rvIvIoCn
�! *
*20.00
*20.00
*G.00
'_ 1 0 6
11-29-83
6.479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
I. 1-2 -
DATE ISSUED
210,75 *20.00°
PERMIT NO.
TOTAL