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'