1983, 12-19 Permit: 83B-2634 Insert PLAN NUMBER APPLICATION/PERMIT PERMIT NUMBER
SPOKANE COUNTY - DEPARTMENT OF BUILDING & SAFETY o
NORTH 811 JEFFERSON /SPOKANE,WASHINGTON 99260/(509)456-3675
APPLICANT: COMPLETE NUMBERED SPACES— PRESS HARD TO MAKE 3 COPIES
MIIIMMMMMF
STREET ADDRESS PARCEL NO.
1• E. 12707 Skyview
LOT BLOCK SUBDIVISION LEGAL DESCRIPTION:
2.
OWNER PHONE PHONE
3. Gary Anderson 928-1743
MAILING ADDRESS ZIP Actual Set Backs In Feet to:
E. 12707 Skyview Ave Spokane, ➢tA 99216 North South [East I West
CONTRACTOR LICENSE gXPIRES PHONE Size of Parcel Zone Classification Residential
Valley Fireplace 1/1/84 922-2780 commercial❑ `: U
4• ADDRESS ZIP Type Const. Occupancy Sprinklered r
E. 16610 Sprague Ave. Veradale, WA 99037 ❑Yes ❑No ❑Req'd.
DESIGNER PHONE New Const.Valuation Remodeled Valuation Total Bldg.Floor Area
5 Contr. License VVALL,'F-177CG
ADDRESS ZIP Main Floor Upper Floors Garage/Storage Greenhouse
CHANGE OF USE FROM TO Cover Deck Uncv.Deck Fin.Basement Unf In.Basement
6.
TYPENo.Baths No.Floors No.Fin.Rooms No.Dwellings
NEW ❑ ALT. 0 AD'N. 0 RPL. 0 MVE.
7. OF WORK
0 BLD. 0 PLMB.,I�MECH. 0 M.H. 0 POOL ❑ OTHER Certifi.of Exempt. Required Yes!: No❑ Number
or Variance Received Yes No❑
DESCRIBE WORK C ( ) / r/N&) Shorelines/Flood Hazard Plans Required❑
8• Installation of LOPI Insert (LX) into masonry fireplac, . Yee❑ Not Applic.❑ Received ❑
VALUATION SODURCE GAS ELECTRIC PUBLIC WATER SEPTICESEWAGE ownership FEES COLLECTED
9. 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
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 RE_VERS IDE FOR REQUIR INSPECTIONS i Plumbing
SIGNATURE OF J 1 APPLICATION ' J'1 i^'2. oG
OWNER OR AGENT < ilk-Q-- `C / DATE IOS. { Mech.
SPECIAL APPROVALS SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE) I
PRELIM. FINAL DATE Plan Check
Env.Health
SEPA
Planning
Modular/
Fire MFG.Home
Prevent.
Other(Specify) V
O
Engineer W
J
7 fl o LL
Utilitiesy//v/1
TOTAL $
SEPA
PERMIT IS NONTRANSFERABLE WHEN MACHINE VALIDATED IN THIS SPACE,
Plans THIS BECOMES A PERMIT.
Exam. PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
Building IN 180 DAYS r, o z; i I ci Jo�
CTALTech. � _
C3 [ PERMI . °