1983, 01-03 Permit: 83A-0023 InsertPLAN NUMBER
APPLICATION/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
1. S. 514 Newer
PARCEL NO.
LOT
2.
OWNER
BLOCK
SUBDIVISION
3 Glen Beach
MAILING ADDRESS
PHONE
924-4227
PHONE
LEGAL DESCRIPTION:
S. 514 Newer Veradale• WA
CONTRACTOR
4 Valley Fireniaoe The.
ADDRESS
E. 16610 Sprague Ave
ZIP
99037
Actual Set Backs In Feet to:
North (South [East I West
LICENSE EXPIRES
PHONE
922-2760
Size of Parcel
Zone Classification
Residential 0
Commercial 0
Veradale, 1YA
ZIP
99037
Type Const.
Occupancy
Spr'nklered
DYes DNo CReq rd.
DESIGNER
5 Contractor License No, VA LL EF 526 01N
ADDRESS
PHONE
New Const. Valuation
Remodeled Valuation
Total Bldg. Floor Area
ZIP
Main Floor
Upper Floors
Garage/Storage
Greenhouse
CHANGE OF USE FROM
6.
TO
Cover Deck
Uncv. Deck
Basement
Basement
TYPE 0 NEW 0 ALT. 0 AD' N. 0 RPL. 0 MVE.
7. OF
WORK ❑ BLD. 0 PLMB. 0 MECH. 0 M.H. 0 POOL
0 OTHER
No. Baths
No. Floors
No. Fin. Rooms
jh4o. Dwellings Uniin.
Certlf 1. of Exempt.
or Variance
Required YesD No0
Received Yes El No❑
Number
8 DESCRIBE WORK Installation of Blaze Princess PTJ-202
Sing 07i s+inc mn
VALUATION SOURCE GAS ELECTRIC
9. UTIOF
LITIES
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 Mating construction or the performance
of construction. SEE REVE - d • E FOR RE • UIRE • SPECTIONS
WATER
PUBLIC 0
PRIVATE 0
SIGNATURE OF
OWNER OR AGENT
SEWAGE
SEPTIC 0
SEWER 0
SPECIAL APPROVALS
PRELIM. FINAL DATE
Env. Health
Planning
Flre
Prevent.
Engineer
Utilities
SEPA
Flans
Exam.
Building
Tech.
Shorelines/Flood Hazard
Yes Not Apollo. 0
Ownership
Public 0 Private 0
Flans Requ red D
Received 0
APPLICATION
DATE �^'—_�_�—�
SPECT LCCO • ITIONS: (SE,EREVERSE SIDE FOR NOTICE)
PERMIT IS NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
FEES COLLECTED
Building
Plumbing
Mech.
Plan Check
SEPA
Modular/
MFG. Horne
Other (Specify)
TOTAL $
PERMIT NUMBER
F3A - 002,5
04* *2000
*20.006
A *000 0
2.32
01'-03-83
2 4479.
eL
WHEN
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATE Ik UEd 3,- 8 3'
PERMIT NO2 4 2
*20,OOfrOTAL