1983, 10-04 Permit: 83A-9904 Insert PLAN NUMBER APPLICATION/PERMIT PERMIT NUMBER
SPOKANE COUNTY - DEPARTMENT OF BUILDING &SAFETY O 7oq'
NORTH 811 JEFFERSON /SPOKANE,WASHINGTON 99260/(509)456-3675
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
STREET ADDRESS PARCEL NO.
1. 13505 E. 12th
LOT BLOCK SUBDIVISION LEGAL DESCRIPTION:
2.
OWNER PHONE PHONE
Gerald Harwood 922-2367
3 MAILING ADDRESS ZIP Actual Set Backs in Feet to:
13505 E. 12th - Spokane, WA _ 99216 North 'South East I West
CONTRACTOR LICENSE EXPIRES PHONE Size of Parcel Zone Classification Residential❑
4. Valley Fireplace 111/84 922-2780 Commercial❑
ADDRESS ZIP Type Const. Occupancy Sprinklered
E. 16610 Sprague Ave. Veradale, WA 99037 ❑Yes ❑No ❑Req'd.
DESIGNER PHONE New Const.Valuation Remodeled Valuation Total Bldg.Floor Area C 4 * * 2 C 0
5 Contr. License ALJ.l P-177CG - * 2 C. 0 0
ADDRESS ZIP Main Floor Upper Floors Garage/Storage Greenhouse
t, * L 0 ,, 2�
V '�i
CHANGE OF USE FROM TO Cover Deck Uncv.Deck Fin.Basement Unf in.Basement
6. 9 9 C 3
No.Baths No.Floors No.Fin.Rooms No.Dwellings 1 0- 0 4 -8 3
TYPE ❑ NEW ❑ ALT. ❑ AD'N. ❑ RPL. ❑ MVE.
7. OF WORK ❑ BLD. ❑ PLMB. ❑ MECH. ❑ M.H. ❑ POOL El OTHER Certifi.of Exempt. Required Yes❑ No❑ Number 6 4 7 (;
or Variance Received Yes❑ Non
DESCRIBE WORK Installation of Arrow No. 1800 using Shorelines/Flood Hazard Plans Required❑
8. Securit Insu ated Pipe and Tile 3eart1l Yes❑ NotApplic.❑ Received ❑
VALUATION SOURCE I GAS ELECTRIC WATER SEWAGE Ownership FEES COLLECTED
9 OF
UTILITIES PUBLIC❑ SEPTIC❑
PRIVATE❑ SEWER❑ Public D 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 Building
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 j
of construction.SEE REVE.1 SE IDE FOR RE IRE INSPECTIONS Plumbing
SIGNATURE OF APPLICATION
OWNER OR AGENT Ca— ^ �✓ .y OA itf2 DATE 1� Mech. ‘IC-40-
SPECIAL APPROVALS SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PRELIM. FINAL DATE Plan Check
Env.Health
SEPA
Planning Modular/
MFG.Home
Fire a
Prevent. ) p
Engineer
Other(Specify) V
W
J_
Utilities ii LL
TOTAL $
SEPA
PERMIT IS NONTRANSFERABLE WHEN MACHINE VALIDATED IN THIS SPACE,
Plans THIS BECOMES A PERMIT.
Exam. I PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED _ r
Building G . IN 180 DAYS — g 4 z o
* 2 a
Tech. /
J I( 4-- DATE ISSUED PERMIT NO. TOTAL