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1984, 01-27 Permit: 84A-774 InsertPLAN NUMBER APPLICATION,/PERMIT SPOKANE COUNTY — DEPARTMENT OF BUILDING & SAFETY NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675 1. APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES STREET ADDRESS East 12011 Frederick PARCEL NO. LOT 2. BLOCK SUBDIVISION 3. OWNER Ron Clark PHONE Q2$ yfl2A PHONE LEGAL DESCRIPTION: MAILING ADDRES East 12011 Frederick ziP99206 4. CONTRACTOR Same ADDRESS LICENSE EXPIRES PHONE Actual Set Backs In Feet to North ISouth [East I West Zone Classification Size of Parcel Residential 0 Commercial 0 ZIP Type Const. Occupancy Spr nklered DYes DNo DReq'd. 5. DESIGNER PHONE New Const. Valuation Remodeled Valuation Total Bldg. Floor Area ADDRESS ZIP Main Floor Upper Floors Garage/Storage Greenhouse 6. CHANGE OF USE FROM TO Cover Deck Uncv. Deckt TYPE, X1 NEW D ALT. D AD' N. D RPL. 7• OF WORK D BLD. D PLMB.$7 MECH. 0 M.H. ❑ MVE. D POOL 0 OTHER N0. Baths No. Floors Fin. Basemen No. Fin. Rooms Untln. Basement No. Dwellings Certifl. of Exempt. or Variance Required YesD No0 Received VesO No0 Number 8. DESCRIBE WORK Installing insert into existing fireplace Shorelines/Flood Hazard Yes0 Not Apollo. 0 Plans Req Ired 0 Received 0 VALUATION 9. SOURCE UTILITIES GAS ELECTRIC WATER PUBLIC 0 PRIVATE 0 SEWAGE SEPTIC 0 SEWER 0 Ownership Public 0 Private 0 I hereby certify that I have read and examined this appl cation 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 INSP CTIONS SIGNATURE OF OWNER OR AGENT APPLICATION - PRELIM. r Z4k 1994 DATE �V(( �^� SPECIAL APPROVALS PRELIM. FINAL DATE Env. Health Planning Fire Prevent. Engineer Utilities SEPA Pans 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) 20.00 TOTAL $ 20.00 PERMIT NUMBER S1A - 774 04* *2000 *20006 A *000 77.38 01-27-84 2 6479. WHEN MACHINE VALIDATED IN THIS SPACE, THIS BECOMES A PERMIT. DATE16aUED2 7 I—k8i4 PERMITNi. 7 4 �2 *2O.00?TTs'