1984, 01-17 Permit: 84A-481 FireplacePLAN NUMBER APPL ICAT ION /PERMIT
SPOKANE COUNTY — DEPARTMENT OF BUILDING & SAFETY
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
STREET ADDRESS
PARCEL NO.
1 . E. 17722 TAontgomery
No. Floors
LOT
BLOCK
SUBDIVISION
LEGAL DESCRIPTION:
2.
I
OWNER
PHONE
PHONE
3. Rand McKern
928-2794
MAILING ADDRESS Gree
ZIP
Actual Set Backs in Feet to:
Ea 17722 Montgomery WA
99016
North South East West
CONTRACTOR
LIC NSP EXPIRES
PHONE
Size of Parcel
Zone Classification
Residential ❑
4 Val ey Fire lane
111/84
922-2780
Shorelines/Flood Hazard
1 commercial ❑
ADDRESS
ZIP
Type Const.
Occupancy
Sprinklered
E 16610 Sprague Ave. Veradale, WA
99037
ELECTRIC
WATER
PUBLIC ❑
❑Yes ❑No ❑Req'd.
DESIGNER
PHONE
New Const. Valuation
Remodeled Valuation
Total Bldg. Floor Area
5 Contr. License ALLEF-177CG
ADDRESS
ZIP
Main Floor
Upper Floors
Garage/Storage
Greenhouse
CHANGE OF USE FROM TO Cover Deck Uncv. Deck Fin. Basement Unfin. Basement
6.
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 3.11DE FOR REQUIRED I SPECTIONS Plumbing
SIGNATURE OF , ( DATEAPPLICATION Mach.
OWNER OR AGENT_4/1
SPECIAL APPROVALS SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE
PRELIM. FINAL DATE
Plan Check
Env. Health
SEPA
Planning
Modular/
Fire MFG. Home
Prevent.
Enaineer I Other (Specify)
Plans
Exam.
�/l
PERMIT IS NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
TOTAL $ '
WHEN MACHINE VALIDATED IN THI
THIS BECOMES A PERMIT.
PERMIT NUMBER
"g-1�_'r r�� � �c
DATE ED PERMIT N ' ' 'j, 0 �OtAL
1
CL
C
G
U
U
No. Baths
No. Floors
No. Fin. Rooms
No. Dwellings
TYPE 11 NEW 1:1 ALT. ❑ AWN. ❑RPL.
11 MVE.
7.
OF
13 OTHER
Certifi. of Exempt.
Required Yes El No❑
Number
WORK El BLD. 1:1PLMB. ElMECH. ElM.H. ❑ POOL
or Variance
Received Yes❑ No[-]
8 DESCRIBE WORK
Shorelines/Flood Hazard
Plans Required ❑
Installation of Arrow, 12000 Insert into
fire laoeo
Yes Not Applic.
❑
Received ❑
VALUATION
SOURCE GAS
OF
ELECTRIC
WATER
PUBLIC ❑
SEWAGE
SEPTIC ❑
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 3.11DE FOR REQUIRED I SPECTIONS Plumbing
SIGNATURE OF , ( DATEAPPLICATION Mach.
OWNER OR AGENT_4/1
SPECIAL APPROVALS SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE
PRELIM. FINAL DATE
Plan Check
Env. Health
SEPA
Planning
Modular/
Fire MFG. Home
Prevent.
Enaineer I Other (Specify)
Plans
Exam.
�/l
PERMIT IS NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
TOTAL $ '
WHEN MACHINE VALIDATED IN THI
THIS BECOMES A PERMIT.
PERMIT NUMBER
"g-1�_'r r�� � �c
DATE ED PERMIT N ' ' 'j, 0 �OtAL
1
CL
C
G
U
U