1984, 01-17 Permit: 84A-477 Chimney, StovePLAN NUMBER APPL ICAT ION /PERMIT
SPOKANE COUNTY - DEPARTMENT OF BUILDING & SAFETY
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
S. 4711
LOT
BLOCk
2.
Size of Parcel
OWNER
3. Archie Ha
MAILING ADDRES.
11504 Val
CONTRACTOR
4 Valley Fir
ADDRESS
E. 16610 S
APPLICANT: COMPLETE NUMBERED SPACES —PRESS HARD TO MAKE 3 COPIES
PARCEL NO.
hwav Court
Const.
VY
la
928-7184
:ane IVA
ue Ave. Veradale, VIA
DESIGNER
C ontr . License -jTAL1.&7-177 CG
v ADDRESS
CHANGE OF USE FROM
6.
TO
IPTION:
PHONE
926-1703
PERMIIT NUMBER
/A
ZIP
99206
Actual Set Backs in Feet to:
North South East West
PHONE
922-2780
Size of Parcel
Zone Classification
1 1Commercial
Residential❑
❑
ZIP
99037
Type Const.
Occupancy
Sprinklered
Dyes ❑No ❑Req'd.
PHONE
New Const. Valuation
Remodeled Valuation
Total Bldg. Floor Area
ZIP
Main Floor
Upper Floors
Garage/Storage
Greenhouse
Plans Required ❑
Cover Dock ncv. Deck
Cover Deck T
Fin. Basement Unfin. Basement
Received ❑
No. Baths
No. Floors
No. Fin. Rooms
No. Dwellings
TYPE ❑ NEW ❑ ALT. ❑ AWN. ❑ RPL. ❑ MVE.
% OF El OTHER
Certifi. of Exempt.
Variance
Required Yes❑ No❑
Number
WOR ❑BLD. El PLMB. E] MECH. El M.H. El POOL
or
Recelved Yes No❑
8 DESCRIBE WORK Installation of Security Insulated
Shorelines/Flood Hazard
Plans Required ❑
_ qn aype
Yes❑ Not Applic. ❑
Received ❑
VALU TION
SOOURCE
GAS
ELECTRIC
PUBLICO
SEPTIC G❑
Ownership
FEES COLLECTED
9
UTILITIES
PRIVATE ❑
SEWER ❑
Public ❑ Private ❑
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
Building
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 REQUIREP INSPECTIONSPlumbing
1 1
I `
SIGNATURE OF i' 1 APPLICATION
Za.Lr
OWNER OR AGENT i DATE
Mach. .
SPECIAL APPROVALS
SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PRELIM. FINAL DATE
Plan Check
Env. Health
SEPA
Planning
Modular/
MFG. Home
Fire
Prevent.
Other (Specify)
Enaineer
I
I
Utilities
Plans PERMIT IS NONTRANSFERABLE
Exam. PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
Building
Tech. IN 180 DAYS
r1,7
TOTAL $
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
�1j },; 47,7E 2��
DATE!SSUE� / — PERMIT NO. TOTAL
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