1983, 12-15 Permit: 83B-2555 Fireplace InsertPLAN NUMBER—� APPLICATION /PERMIT
SPOKANE COUNTY — DEPARTMENT OF BUILDING & SAFETY
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
TYPE NEW ❑ ALT. ❑ Ap'N. ❑ RPL. ElMVE.
7 WORK 11OF -'NEW
❑ PLMB. MECH. ❑ M.H. POOL E) OTHER
No. Baths
APPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 3 COPIES
No. Fin. Rooms
STREET ADDRESS
Certifi.ofExempt.
or Variance
Required Yes❑ NOD
Received Yes❑ No❑
PAR EL NO.
DESCRIBE WORK
8 • r�f l't.lE� t fry �af'�(LT
Shorelines/ Flood Hazard
Yes ❑ Not Appl ic. ❑
Plans Required ❑
Received ❑
VALUATION I
9•
SOURCE
UTILITIES
GAS
LOT
BLOCK
SUBDIVISION
Ownership
Public ❑ Private ❑
LEGAL DESCRIPTION:
2.
1 hereby certify that I have read and examined this application and have read the "NOTICE" provisions included on
I
Building
thority to violate or cancel the provisions of any other state or local law regulating construction or the performance
Iconstruction. SEE REVERSE SIDE FOR REQUIRED INSPECTIONS
SIGNATURE OF / APPLICAT N
OWNER OR AGENDATE
IC�,�
OWNER
SPECIAL APPROVALS
PHONE
PHONE
3.
U_oq o
Ck'2E 4r \ Z(;
MAILING ADDRESS
ZIP
Actual Set Backs in Feet to:
Planning
Jv . k\%4
TZ -VI.
�lalC��
North South East West
CONTRACTOR
LICENSE EXPIRES
PHONE
Size of Parcel
Zone Classification
Residential ❑
Commercial ❑
4.
ADDRESS
ZIP
Type Const.
Occupancy
Sprinklered
❑Yes ONO ❑Req'd.
DESIGNER
PHONE
New Const. Valuation
Remodeled Valuation
Total Bldg. Floor Area
5.
ADDRESS
ZIP
Main Floor
Upper Floors
Garage/Storage
Greenhouse
CHANGE OF USE FROM
TO
Cover DeckUncv.
Deck
Fin. Basement
Unfin. Basement
6.
TYPE NEW ❑ ALT. ❑ Ap'N. ❑ RPL. ElMVE.
7 WORK 11OF -'NEW
❑ PLMB. MECH. ❑ M.H. POOL E) OTHER
No. Baths
No. Floors
No. Fin. Rooms
No. Dwellings
Certifi.ofExempt.
or Variance
Required Yes❑ NOD
Received Yes❑ No❑
Number
DESCRIBE WORK
8 • r�f l't.lE� t fry �af'�(LT
Shorelines/ Flood Hazard
Yes ❑ Not Appl ic. ❑
Plans Required ❑
Received ❑
VALUATION I
9•
SOURCE
UTILITIES
GAS
ELECTRIC
ER
PUBLIC El
PRIVATE ❑
SEPTIC El
SEWER ❑
Ownership
Public ❑ Private ❑
FEES COLLECTED
1 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 compiled with whether specified herein or not. The granting of a permit does not presume to give au-
Building
thority to violate or cancel the provisions of any other state or local law regulating construction or the performance
Iconstruction. SEE REVERSE SIDE FOR REQUIRED INSPECTIONS
SIGNATURE OF / APPLICAT N
OWNER OR AGENDATE
IC�,�
Plumbing
Mach.
SPECIAL APPROVALS
SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PRELIM. FINAL DAT
Plan Check
Env. Health
SEPA
Modular/
Planning
MFG.Home
Engineer I I I I I Other (Specify)
Utilities
TOTAL $�'�''�
SEPA
MACHINE VALIDA
Plans PERMIT IS NONTRANSFERABLE HEIS BECOMES A PERM TT
Exam. PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
Building IN 180 DAYS 15 _S ' 5DATE ED
PERMIT NUMBER
8� -asslS
IS SPACE,
PERMIT#I .. >. 5 c,-5
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