1984, 04-11 Permit: 84A-3225 Insert PLAN NUMBER APPLICATION/PERMIT PERMIT NUMBER
SPOKANE COUNTY - DEPARTMENT OF BUILDING &SAFETY S'I4 - 3
NORTH 811 JEFFERSON /SPOKANE,WASHINGTON 99260/(509)456-3675
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
STREET ADDRESS FARCE NO.
1. N. 422 Sargent Rd.
LOT BLOCK SUBDIVISION LEGAL DESCRIPTION:
2.
OWNER PHONE PHONE
3.
Ruth DeHart 927-0178 Actual Set Backs in Feet to:
N. 422 Sargent Rd.MAILING ADDRESS ZIP 99206 North South East i West
CONTRACTOR LICENSE EXPIRES PHONE Size of Parcel Zone Classification Residential 0
Valley Fireplace 1/1/85 922-2780 Commercial❑ , /! * � `= -.
4. ApDRE S ZIP Type Const. Occupancy Sprinklered L (, 0
L. 16610 Sprague Ave. Veradale, WA 99037 ❑Yes ❑No ❑Req'd.
DESIGNER PHONE New Const.Valuation Remodeled Valuation Total Bldg.Floor Area i
5 Contr. License TALLL'F-177CG - ,
ADDRESS ZIP Main Floor Upper Floors Garage/Storage Greenhouse
_ i. - — 1 1 /i
CHANGE OF USE FROM TO Cover Deck Uncv.Deck Fin.Basement Unf in.Basement
4 '7O
s.
No.Baths No.Floors No.Fin.Rooms No.Dwellings
TYPE ❑ NEW ❑ ALT. ❑ AD'N. ❑ RPL. ❑ MVE.
7. OF ❑ OTHER
WORK ❑ BLD. ❑ PLMB. ❑ MECH. ❑ M.H. ❑ POOL avarianExempt. Required Yes No❑ Number
Received Yes No
DESCRIBE WORK Installation of LOPI FL Insert Shorelines/Flood Hazard Plans Required❑
8. YesO Not Applic.❑ Received ❑
into existing fi eplace.
VALUATION SOURCEDF
OF
GAS ELECTRIC WATER SEWAGE 'Ownership FEES COLLECTED
9 PUBLIC❑ SEPTIC 0
PRIVATE El SEWER 0 Public❑Private 0
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 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 REOUINSPECTIONS Plumbing
SIGNATURE OF !/tet`a APPLICATION ////�" f
-26- L
OWNER OR AGENT - DATEMech.
SPECIAL APPROVALS / SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
Plan Check
PRELIM. FINAL DATE
Env.Health
SEPA
Planning Modular/
MFG.Home
Fire d
Prevent. 0
Engineer Other(Specify) NJ
J
Utilities
TOTAL $
SEPA
WHEN MACHINE VALIDATED IN THIS SPACE,
Plans PERMIT IS NONTRANSFERABLE THIS BECOMES A PERMIT.
Exam. PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
Building
ech mgA
`�� I N 180 DAYS EQSu •r�.1 -8 4 ,a.2,5 z * 2 0, O 0 SOMAL
1 �f DAT UE PERMIT