1980, 12-18 Permit: 80B-5020 Insert PLAN NUMBERI APPLICATION/PERMIT / PERMIT NUMBER
SPOKANE COUNTY - BUILDING CODES DEPARTMENT M 3 - '01-2--c)
NORTH 811 JEFFERSON / SPOKANE,WASHINGTON 99260 / (509)456-3675 DATE
111/ APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 4 COPIES
JOB ADDRESS \::' 4 * * 1 1,0 0
1. 4213 S. n `41--w--01,24 1"0-7/..a___� LEGAL DESCRIPTION — SEE ATTACHED * 1 1 0 0 u
LOT BLOCK SUBDIVISION PARCEL NUMBER/S
2. * 11.008
OWNER PHE A * O. Q `1
Hugh Ambeland 1 3175
3 ADDRESS ZIP Required Set Backs in Feet 501. 9f
4213 S. Sunderlin North 'South East
CONTRACTOR PHONE Size of Parcel Zone Classification(west 1 2— 1 8—8 0
Valley Fireplace, Inc. 922-2780 g E6 4 7 9.
4. ADDRESS ZIP Type Const. Occupancy Sprinklered
E. 16610 Sprague Ave. 99037 Lilies ❑No ❑ Req'd.
DESIGNER Veradale, tA. PHONE Valuation Building Area in Sq. Ft.
5 Contractor Specialty
ADDRESS No. VA LL ;IT 0L ZIP DWL Area I Basement Area Garage Area Storage —
CHANGE OF USE FROM TO Split Entry Split Level Rancher
6.
No. Baths No. Floors No. Rooms Rec. Room
TYPE ' NEW ❑ ALT. ❑ AD'N. ❑ RPL. ❑ MVE.
7. OF �/ II OTHER -
CERTIFICATE Req'd. Recd. Not Req'd.
WORK CII
BLD. ❑ PLMB. aL MECH: 0 M.H. 1:1 POOL
of EXEMPTION
DESCRIBE WORK Install Majestic "Athena" Free Standing fireplace with insulated FEES COLLECTED
8. chimney and hook up Blaze King Top Jet wood s ove in hAsPAnt-
VALUATION Source GAS ELECTRIC WATER 1 SEWER
of
9. Utilities Single $
I hereby certify that I have read and examined this application and have read the "NOTICE" provisions included a;
on reverse side, and know the same to be true and correct. All provisions of laws and ordinances governing this Building
type of work will be complied with whether specified herein or not. The granting of a permit does not presume
to give authority to violate or cancel the provisions of any other state or loc aw regulat g cons �
uction or the
performance of construction 4(. ` •lambing
DATE /..v?�" / l SIGTURE / / / Mech. //�Tr
SPECIAL APPROVALS SPECIAL CONDITIONS:
DEPT. REQ'D. REC'D. Plan Check
Env.Health Ready for inspection — Inspector
was there when installing. SEPA
Planning U
— u_i
Mobile Home z
Fire Marshall
(/
Co. Engineer /1 Other (Specify) //// '
Utilities // 6
TOTAL $
Zone Clearance
10
14'3- MACHINE
HIE VALIDATED
IN THIS SPACE,
PACE,
SEPA Checklist . --(7.,,,.."------'`::'2- THIS BC ARMT
V/�/ 121 & 8U 502O Z *11002. 1='
.1
DATEOFF' '
APPRO' i OR ISSUANCE _