1983, 09-06 Permit: 83A-8665 Fireplace InsertPLAN NUMBER APPL ICAT ION /PERMIT
SPOKANE COUNTY - DEPARTMENT OF BUILDING & SAFETY
�( NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
1. t
LOT I BLOCK
2.
OW R ,r
3.
MAILI G ADDRESS
CONTRACTOR
4. SA
ADDRESS
DESIGNER
5.
ADDRESS
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
_ A it _ PARCEL NO.
CHANGE OF USE FROM
6.
TO
LICENSE EXPIRES
_AC4=)- IIIII
ZIP Actual Set Backs in Feet tc
9Ct North (South
ZIP S Main Floor I Upper
I YVE e1NEW ❑ ALT. WM
OF ❑ RPL. ElMVE.
7 WORK ❑ BLD. ❑ PLM B. ECH. ❑ M.H. ❑ POOL ❑OTHER
East I West
Zone Classification Residential ❑
Commercial ❑
Sprinklered
Dyes ❑No ❑Req'd.
;d Valuation Total Bldg. Floor Area
Garage/Storage Greenhouse
Fin. Basement Unfin. Basement
No. Fin. Rooms No. Dwellings
Received Yes El No❑
DESCRIBE Wq.RK ( Shorelines/ Flood Hazard Plans Required ❑
8. "SOOUF
Yes❑ Not Applic. ❑ Received ❑
VALUATION GAS ELECTRIC WATER SEWAGE Ownership PUBLIC ❑ SEPTIC ❑ FEES COLLECTED
UTILITIES PRIVATE ❑ SEWER ❑ Public ❑ Private ❑
I 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-
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 REO ED INSPECTIONS
SIGNATURE OF ( APPLICATION e/
OWNER OR AGENT DATE �� —
SPECIAL APPROVALS SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PRELIM. FINAL DATE
Env. Health
Planning
Fire
Prevent.
Utilities
Plans PERMIT IS NONTRANSFERABLE
Exam. PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
BuildingIN 180 DAYS
Tech. ffl1jtTq_(j
Building
Plumbing
Mach. G.
Plan Check
SEPA
Modular/
MFG. Home
Other (Specify)
TOTAL $ — L__
WHEN MACHINE VALIDATED
THIS BECOMES A PERMIT.
PERMITNUMBER �_
8c10i
DATEISSUrEDO 3 0 PERMITU. 6' 5 5 * 2 O. O O flo�AL
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