1983, 09-06 Permit: 83A-8643 Fireplace 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 PARCEL NO.
2. LOT BLOCK I SUBDIVISION LEGAL DESCRIPTION:
gOvR�<PHONE
�r�,n
LIN7G PRESS /
of v (
ZIP
Actual Set Backs in Feet to:
I �
North South East
West
CONTRACTOR
��� � ? %�
LICENSE EXPIRES
PHON
" 7M99'
Size of Parcel
Zone Classification
Residential ❑
Commercial ❑
4. C . /
ADDRESj__
ZIP
Type Const. Occupancy
Sprinklered
1'1'6r)6
Dyes ❑No ❑Req'd.
DESIGNER
PHONE
New Const. Valuation
Remodeled Valuation
Total Bldg. Floor Area
5.
ADDRESS
ZIP
Main Floor Upper
Floors
Garage/Storage
Greenhouse
CHANGE OF USE FROM
TO
Cover Deck
Uncv. Deck
Fin. Basement
Unfin. Basement
s.
No.
Floors
No. Fin. Rooms
No. Dwellings
TYPE 11 NEW C3 ALT. 11AD' N. 11 RPL. 11MVE.
!!!:]
7.
WORK ElBLD. ElPLMB.`&� IVIECH. ElM.H. 1)POOL OF ❑OTHER
Cartifi.ofExempt.
Required
Yes❑ No❑
Number
or Variance
Received
Yes❑ No❑
DESCRIBEWORK
8 �/
Shorelines/ Flood Hazard
Plans Required ❑
JJ—
sem'/ / fL
Yes Not Applic. ❑
Received ❑
VALUATION
I SOOURCE
GAS
ELECTRIC
PUBLICWATEO
SEPTIC ElOwnership
FEES COLLECTED
9•
UTILITIES
PRIVATE ❑
SEWER ❑
Public ❑ Private ❑
1 hereby certify that I have read and examined this application and have read the "NOTICE"
provi§ions 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-
Building
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 REQ IRED INSPECTIONS
Plumbing
SIGNATURE OF APPLICATION
7:4 -
'��•
OWNER OR AGENT `-'� DATE
Mech.
SPECIAL APPRO ALS SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PRELIM. FINAL DATE
Env. Health
Planning
Fire
Prevent.
Utilities
Plans I I i I PERMIT IS NONTRANSFERABLE
Exam. PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
Tech mg IN 180 DAYS
Plan Check
SEPA
Modular f
MFG. Home
Other (Specify)
PERMIT NUMBER
S-;3 A 443
TOTAL $ �'a=� 1
WHEN MACHINE VALIDATED IN THIS
THIS BECOMES A PERMIT.
j
DATESSUEI 6 PERMAM6. `t1 5 z * 2 O. 0 0 0
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