1982, 11-03 Permit: 82B-0510 Insert PLAN NUMBER APPLICATION/PERMIT " PERMIT NUMBER
SPOKANE COUNTY - BUILDING CODES DEPARTMENT /i"� 0,5 1,0
@J.
NORTH 811 JEFFERSON / SPOKANE,WASHINGTON 99260 / (509)456-3675
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
1 JOB ADDRESS
14119 E. 15th Ave. LspAL DESCRIPTION — SEE ATTACHED
LOT BLOCK SUBDIVISION PARCEL NUMBER/S
2.
OWNER PHONE
3 1Clarence Gormsen 928 8646 `' " * (' 00
ADDRESS ZIP Actual Set Backs in Feet * 2 i" v
L� U�
14119 E. 15th Ave. North 'South East 'West I., * `, t?
CONTRACTOR PHONE Size of Parcel Zone Classification
Valley Fireplace Inc. 922 2780 69
4' ADDRESS ZIP Type Const. Occupancy Sprinklered
L. 16610 Sprague Ave. ,_ _. �
VNritdalp—, 1 _C IriA 99037 ❑Yes ❑No 0 Req'd. 1J—C,
DESIGNER PHONE Valuation Building Area in Sq. Ft. _ , (t 7 C:
Contractor License No. VA LL EF
5. ADDRESS S26 17,2 ZIP Main Floor Upper Floors Garage Area Storage
CHANGE OF USE FROM TO Area of Decks Finished Basement Unfin. Basement
6.
TYPE �/ No. Baths No. Stories No. Rooms No. of Dwellings
Lf NEW ❑ ALT. ❑ AD'N. 0 RPL. 0 MVE.
7, OFCJ�, M ❑ OTHER
WORK ❑ BLD. 0 PLMB. ECH. CIM.H. 0 POOL CERTIFICATE Req'd. Rec'd. Not Req'd.
of EXEMPTION
DESCRIBE WORK Install "Blaze Princess" PFF 402 Firepla. x Enum. Dist. I Location (Area) ' FEES COLLECTED
8. Furnace into masonry fireplace w/hearth extension. 1
VALUATION SOURCE GAS ELECTRIC WATER SEWER
Ownership USE CODE
OF
9. UTILITIES • Public ❑Private 0 Single $
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 Building
type of work will be complied with whether specified herein or not. The granting of a permit does not presume
to give authority 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 a Plumbing
DATE OF APPLICATION //4- -"'"(fSIGNATURE OF APPLICANT `'LJI `'"'%T"•�^�- - Mech. ��SPECIAL APPROVALSSPECIAL CONDITIONS: ✓
NAME DATE Plan Check
Env. Health
SEPA
Planning 0
C:)
- w
Fire Marshall Mobile Home
EZ
Co. Engineer Other(Specify)
Utilities
TOTAL $
Plans Examiner
WHEN MACHINE VALIDATED IN THIS SPACE,
SEPA Checklist THIS BECOMES A PERMIT.
IIINGEFillt PERMIT IS NONTRANSFERABLE 111 0 3 =8 2 51,0 z * 2 O. 0 0 2
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE DATE ISSUED PERMIT NO. TOTAL