1983, 07-22 Permit: 83A-6860 FireplacePLAN NUMBER APPLIICATION /PERMIT PERMITNUMBER
J SPOKANE COUNTY - DEPARTMENT OF BUILDING & SAFETY
NORTH 811 JEFFERSON / SPOKANC, WASSAINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
STREETADDRESS PARCEL NO.
LOT
BLOCK
SUBDIVISION
LEGAL DESCRIPTION:
2.
OWNER
PHONE
PHONE
3.
a -t)si.s
MAILING ADDRESS
ZIP
Actual Set Backs in Feet to:
f✓ • ( C7ct NoILW
%a.
North South East West
-
CONTRACTOR
LICENSE EXPIRES
PHONE
Size of Parcel
Zone Classification
Residential
S�/y�E
4.
Commercial ❑
ADDRESS
ZIP
Type Const. Occupancy
Sprinklered
Dyes ❑No OReq'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 Deck
Uncv. Deck
Fin. Basement
Unf in. Basement
6.
No. Baths No.
Floors
No. Fin. Rooms
No. Dwellings
TYPE NEW ❑ ALT. ❑AD' N. El RPL. ❑ MVE.
7. ❑OTHER
Certif I. of Exempt.
Required
Yes❑ No❑ Number
WORK El BLD. ElPLMB. 5?/MECH. ❑ M.H. ❑ POOL
or Variance
I Received
Yes No❑
Plans Required ❑
DESCRIBE WORK
8
Shorelines/ Flood Hazard
/JC-
Yes❑ Not Applic. ❑
Received ❑
FEES COLLECTED
VALUATION
9•
SOOUFCE
GAS
ELECTRIC
PUBIC WATER
SEWAGE
SEPTIIC ❑
Ownership
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
work will be complied 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
of construction. SEE REVERSE SIDE FOR REQUIRED INSPECTIONS
Plumbing
SIGNATURE OF /�- APPLICATION
r
OWNERORAGEN f f/� /irti+�. - DATE A �-_ —
Mach. 2D.
SPECIAL APPROVALS
SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PRELIM. FINAL
DATE
(� ��
2�t�
Plan Check
Env. Health
t'D(� l l�Li�Gkl1 t/b I�DBQ 26J
SEPA
Planning
Modular/
MFG.Home
Other (Specify)
�.
d
O
V
Fire
Prevent.
Engineer
W
J_
ILL.
Utilities
TOTAL $ 2o•c�
SEPA
PERMIT IS NONTRANSFERABLE
MACHINE
HEIS BECOMES A PERM TTED IN THIS SPACE,
Plans
Exam.
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
' � * O Oa0
DATA16-aQ3 PERMIS.(• % J AL
Building
Tech.