1984, 01-10 Permit: 84A-245 FireplacePLAN 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?) r 5
PARCEI NO. w
2.
3.
4.
ADDRESS
LOT BLOCK SUBDIVISION
MAILING ADDRESS
PHONE
LICENSE EXPIRES
5.
DESIGNER
ADDRESS
CHANGE OF USE FROM
PHONE
ZIP
LEGAL DESCRIPTION:
0 Actual Set Backs in Feet to:
'3 North (South East West
PHONE
ZIP
PHONE
ZIP
TO
TYPE /NEW ❑ ALT. ❑ AD' N. ❑ RPL. ❑ MVE. ,—,/OTHER
7. OF �a
WORK ❑ BLD. ❑ PLMB. ❑ MECH. ❑ M.H. 10 POOL '
DESCRIBE WORK
VALUATION
9.
M / ,0 N W's .1v2E17LAGe.NS R%
SOURCE GAS ELECTRIC WAT R SEWAGE
OF PUBLIC E SEPTIC ❑
UTILITIES PRIVATE ❑ SEWER E
Size of Parcel
Type Const. Occupancy
New Const. Valuation
Main Floor
Cover Deck
No. Baths
Certifi. of Exempt.
or Variance
Zone Classification
Residential 0
Commercial E
Spr'nklered
❑Yes No ❑ Req 'd.
Remodeled Valuation
Garage/Storage
Total Bldg. Floor Area
No. Floors
G eenhouse
Fin. Basement
No. Fin. Rooms
Required Vest: NoE
Received Yes No El
Unfin. Basement
No. Dwellings
Number
Shorelines/Flood Hazard Plans Required L
Yes NotApplic. ❑ Received ❑
Ownership
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
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 RE UI INSPECTIONS
SIGNATURE OF 0L7 41 APPLICATION 0 dI
OWNER OR AGENT t- DATE a / `
' /
SPECIAL APPROVALS
PRELIM. FINAL DATE
Env. Health
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
ig
SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
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
02* *3000
A
*30.006
*C00 8
24.48
01-10-84
6479,
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATE ISSUE 0 -8 4
PERMIT NO. 4, ) 5:
*30.00gQAL