1984, 10-23 Permit App: 0002973 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
1 . i.. CIC J. ' WTI
PARCEL NO.
LOT BLOCK SUBDIVISION
2. It` rition to Opportunity
3.
OWNER
Tewinkel
PHONE
926-2646
MAILING ADDRESS
1815 iwoodlawn Rc. Spokane, 11U.
4.
CONTRACTOR LICENSE EXPIRES
ADDRESS
5
•
DESIGNER
Terrac,
PHONE
ZIP
PHONE
ZIP
PHONE
LEGAL DESCRIPTION:
Actual Set Backs in Feet to:
North I South East I West
Size of Parcel Zone Classification
Residential
Commercial
Type Const.
Occupancy
Sprinklered
^:Yes CNo Req 'd.
New Const. Valuation
Remodeled Valuation Total Bldg. Floor Area
ADDRESS
ZIP
Main Floor
Upper Floors
Garage/Storage
Greenhouse
CHANGE OF USE FROM
6.
TO
Cover Deck
Uncv. Deck
Fin. Basement
Unfin. Basement
TYPE C NEW C ALT. E AD' N. 1 RPL. MVE.
7 OF 7 OTHER
WORK BLD. PLMB. C MECH. - M.H. POOL
No. Baths
No. Floors
No. Fin. Rooms
No. Dwellings
Certifi. of Exempt.
or Variance
Required Yesi".
Yes? No
Number
DESCRIBE WORK
8.
Shorelines/Flood Hazard
Yes Not Applic.
Plans Required C
Received G
VALUATION
9.
SOURCE
OF
UTILITIES
GAS
ELECTRIC
WATER
PUBLIC
PRIVATE
SEWAGE
SEPTIC -
SEWER '
Ownership
Public E 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
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 REQUIRED INSPECTIONS
SIGNATURE OF �. Ftfkk CA
APPLICATION 7 _ �i A
OWNER OR AGENT DATE
SPECIAL APPROVALS SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PRELIM. FINAL DATE
Env. Health
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
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. Home
Other (Specify)
TOTAL $
PERMIT NUMBER
WHEN MACHINE VALIDATE
THIS BECOMES A PERMIT.
DATE ISSUED
D IN THIS SPACE,
PERMIT NO. TOTA