1984, 01-17 Permit: 84A-485 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
1.
2.
STREET ADDRESS
N. 4505 Conklin
LOT
BLOCK
PARCEL NO.
SUBDIVISION
3
4.
5.
OWNER
David Braaten
MAILING ADDRESS
N. 4505 Conklin
CONTRACTOR
Valley Fireplace
PHONE
926-2640
PHONE
LEGAL DESCRIPTION:
Spokane. WA
ZIP
99216
Actual Set Backs in Feet to:
North !South
LICENSE XPIRES
1/1/64
PHONE
922-2780
Size of Parcel
11 Zone Classification
East
West
Residential ❑
Commercial ❑
ADDRESS
E. 16610 Sprague
DESIGNER
Contr. License
ADDRESS
Ave. Veradale, WA
ZIP
99037
Type Const.
Occupancy
Sprinklered
❑Yes ❑No ❑Req'd.
liVALLt7-1770G
PHONE
New Const. Valuation
Remode ed Valuation
Total Bldg. Floor Area
ZIP
Main Floor
Upper Floors
Garage/Storage
Greenhouse
CHANGE OF USE FROM
6.
TO
Cover Deck
Uncv. Deck
Fin. Basement
Unfin. Basement
TYPE NEW
7. OF
WORK 111BLD.
❑ ALT. ❑ AD' N. ❑ RPL. ❑ MVE.
❑ PLMB.MECH. ❑ M.H. ❑ POOL ❑ OTHER
,XI
No. Baths
No. Floors
No. Fin. Rooms
No. Dwellings
Certifi. of Exempt.
or Variance
Required Yes No❑
Received Yes❑ No❑
Number
8.
DESCRIBE WORK
Installation
of Convector Insert into Z.0 fireplace.
Shorelines/Flood Hazard
Yes Not Applic. ❑
Plans Required ❑
Received ❑
VALUATION
9.
SOURCE
UTILITIES
GAS
ELECTRIC
WATER
PUBLIC ❑
PRIVATE ❑
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 IPE FOR REQUIRE NSPECTIONS
SIGNATURE OF
DATECATION I 0
OWNER OR AGENT )APPLIi
SPECIAL APPROVALS SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PRELIM. FINAL DATE
Env. Health
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
/4/
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)
f CQ
TOTAL $
PERMIT NUMBER
4A -lbw
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATE4SSUEDLi 7
1
PERMIT Nb. 8. 5 * 2 1) 0 0 IOWAL