1983, 02-03 Permit: 83A-811 Fireplace PLAN NUMBER APPLICATION/PERMIT PERMIITy,UMBER
SPOKANE COUNTY — DEPARTMENT OF BUILDING &SAFETY e2'- A-
(I) NORTH 811 JEFFERSON/SPOKANE,NASHINGTON 99260/(509)456-3675
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
1 STREET/1DDRES3 t�� 4, �,{ PARCEL NO. 4- r.. D .,-2-co
�y�2-co
LQ,T UV BLOCK SUBDIVISION_ _�^�"' LEGAL DESCRIPTION: v
2. Cc> 00012
3. OWr I C`".1f 514\1 r:let, pr..
Y 4\1 -00,7 PHONE
T, i Actual Set Backs in Feet to: K16
MA(jNG4. r 5,2.0 Ce7 North (South I`E4ast, I West r.-...... '
CONTE K E LICENSE EXPIRES PHONE Size of Parcel Zone Classification Residential Q
4. ���,,�,jjCommercial 0
•
ADDRESS ZIP TypeCqutKi u ncy Sprinklered
❑Yes ❑No ❑Reg'd.
DESIGNER PHONE New Const.Valuation Remodeled Valuation - Total Bldg.For Area
5. ADDRESS ZIP Main Floor Upper Floors Garage/Storage Greenhouse
CHANGE OF USE FROM TO Cover Deck Uncv.Deck Fin.Basement Unfin.Basement
6.
No.Baths No.Floors No.Fin.Rooms No.Dwellings
TYPE 0 I.EW /ALT. 0 AD'N. El RPL. 0 MVE.
7. OF WORK BLD 0 PLMB. 0 MECH. 0 M.H. 0 POOL 0 OTHER Certifi.of Exempt. Required Yes No❑ Number
or Variance Received Yes❑ No❑
8. DESC �WQRKO, I � I Shorelines/FloodA Hazard Plans Required 0
�j IV Yes❑ Not Applic.0 Received 0
VAL A ION SOURCE GAS ELECTRIC WATER SEWAGE Ownership
9. ® UTILOITIES PRIVATE 0 SEWEPUBLIC 0 R 0 FEES COLLECTED
Public❑Private>Z�
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
. .C.9
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 • ovisions of any other state or local law regulating construction or the performance
of construction.SEE REVE'- IDE FOR REQ IRED,N PECTIONS Plumbing
SIGNATURE OF _ ~ . 6) / APPLICATION ..7_
OWNER OR AGENT /i A t= A'. -�I i'- /._i 4 SATE .� _ �--)C_ Mech.
SPECIAL APPROVALS SPECIAL CONDITIONS: ( ' E REVERSE SIDE FOR NOTICE)
PRELIM. FINAL DATE Plan Check
Env.Health
SEPA
Planning
Modular/
Fire MFG.Home y.
LL
Prevent.
O
Engineer Other(Specify) W
J_
Utilities LL
TOTAL $
SEPA
WHEN MACHINE VALIDATED IN THIS SPACE,
Plans PERMIT IS NONTRANSFERABLE THIS BECOMES A PERMIT.
Exam. PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
Building o R 1
` �' IN 180 DAYS; DATE EDO 3 8 PERMIT NO IL 1 z * 2 O.0 01fbtAL
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