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1983, 11-03 Permit: 83B-1267 Insert PLAN NUMBER APPLICATION/PERMIT PERMIT NUMBER SPOKANE COUNTY — DEPARTMENT OF BUILDING &SAFETY g'315 - I?-67 NORTH 811 JEFFERSON/SPOKANE,WASHINGTON 99260/(509)456-3675 APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES STREET ADDRESS PARCEL NO. 1. E. 14118 - 19th Ave. LOT BLOCK SUBDIVISION LEGAL DESCRIPTION: 2. OWNER PHONE PHONE Tony Broyles 924-4977 3. MAILING ADDRESS ZIP Actual Set Backs in Feet to: E. 14118 - 19th Ave. 99206 North !South (East 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 0 N ❑Req'd. DESIGNER PHONE New Const.Valuation Remodeled Valuation Total Bldg.Floor Area Contr. License WALLET-177CG - ADDRESS ZIP Main Floor Upper Floors Garage/Storage Greenhouse CHANGE OF USE FROM TO Cover Deck Uncv.Deck Fin.Basement Unf in.Basement 6. No.Barns No.Floors No.Fin.Rooms No.Dwellings TYPENEW ❑ ALT. ❑ 9,N. ❑ RPL. ❑ MVE. 1 7. OF WORK ❑ BLD. ❑ PLMB. MECH. ❑ M.H. ❑ POOL ❑ OTHER Certifi.of Exempt. Required Yes No❑ Number or Variance Received Yes No❑ DESCRIBE WORK Installation of Conveotor Insert Shorelines/Flood Hazard Plans Required D . 8. In existing fireplace. Yes Not Applic.❑ Received 0 VALUATION 1 SOURCE GAS ELECTRIC WATER SEWAGE Ownership FEES COLLECTED 9 I OF UTILITIES PUBLIC❑ SEPTIC❑ PRIVATE 0 SEWER 0 Public 0 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 of construction.SEE REVERSE SIDE FOR REQUIRED INSP CTIONS Plumbing SIGNATURE OF ' .) I APPLICATION 7WNER OR AGENT L-rl=. C.!/r•-•��,' DATE H L/,. � Mech. Z©t SPECIAL APPROVALS SPECIAL CONDITIONS:(SEE REVERSE SIDE FOR NOTICE) Plan Check PRELIM. FINAL DATE Env.Health SEPA Planning Modular/ MFG.Home Fire d Prevent. O Other(Specify) v Engineer Nd J_ Utilities LL' TOTAL $ SEPA MACHINE Plans PERMIT IS NONTRANSFERABLE THIS BECOMES A PERM TTED IN THIS SPACE, Exam. PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED .. Building j( IN 180 DAYS 11 — 3`—8 3 12 6.7 * 2 a. ° Tech. ( DATE ISSUED PERMIT NO. TOTAL