1982, 11-18 Permit: 82B-1177 Insert PLAN NUMBER APPLICATION/PERMIT PERMIT NUMBER
1Y'i &z..1- 11 1 7
SPOKANE COUNTY - BU1Lb1NG CODES DEPARTMENT
NORTH 811 JEFFERSON / SPOKANE,WASHINGTON 99260 / (509) 456-3675
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APPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 3 COPIES
JOB ADDRESS
1, L. 10811 – 21st LEGAL DESCRIPTION - SEE ATTACHED
LOT BLOCK SUBDIVISION PARCEL NUMBER/S
l; a * - * 2000
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2. * % �i O l%nY U
OWNER PHONE * �,
3 Shirley Bates 928 9244 a r 0 c,
ADDRESS ZIP Actual Set Backs in Feet 1 1 7,
L. 10811 – 21st North 'South East
CONTRACTOR PHONE Size of Parcel Zone Classification(West 1 1 - 1 8-8 2
Valley Fireplace Inc. 922 2780 6 4 7 9,
4' ADDRESS ZIP Type Const. Occupancy Sprinklered
H+. 16610 Sprague Ave. 99037 ❑Yes ONo ❑ Req'd.
DESIGNER Vcfxaalu, WA 99037 PHONE Valuation Building Area in Sq. Ft.
5. Contractor License No. VA LL LF
ADDRESS 326 O,N 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
NEW ❑ ALT. ❑ N. ❑ RPL. ❑ MVE. '_
7, OF 0 OTHER
WORK 0 BLD. 0 PLMB. MECH. 0 M.H. 0 POOL CERTIFICATE Req'd. Rec'd. Not Req'd.
of EXEMPTION
DESCRIBE WORK Install "Blaze Princess" Fireplace Furn e Enum. Dist, I Location (Area)
8. Insert into masonry fireplace with hearth extension. I FEES COLLECTED
VALUATION SOURCE GAS ELECTRIC WATER SEWER Ownership USE CODE
OF
9. UTILITIES Public 0 Private 0 Single $
I hereby certify that I have read and examined this application and have read the "NOTICE" provisions included
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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 Building
to give authority to violate or cancel the provisions of any other state or local law regulating construction or the
performance of construction. EE REVERSE SIDE FOR REQUIRED INSPECTIONS Plumbing
07,..,,..eb.e e.e•C 7.; ,,yd„,
DATE OF APPLICATION / –/ / r 2—SIGNATURE OF APPLICANT -,e-ltd Mech. �e./°
SPECIAL APPROVALS SPECIAL CONDITIONS:
NAME DATE Plan Check
Env. Health
SEPA
Planning v
w
Fire Marshall Mobile Home -J
Co. Engineer Other(Specify)
Utilities
TOTAL $
Plans Examiner
WHEN MACHINE VALIDATED IN THIS SPACE,
SEPA Checklist THIS BECOMES A PERMIT.
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.. •' g T- hnicia PERMIT IS NONTRANSFERABLE L L7.� 1 8 •`8'2 117,7 z *20.00 a -
-
�- - . PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
i DATE ISSUED PERMIT NO. TOTAL 1
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