1981, 10-08 Permit: 81B-0441 Insert PLAN NUMBER APPLICATION/PERMIT PERMIT NUMBER
�1 SPOKANE COUNTY — BUILDING CODES DEPARTMENT a�� —01
11/ NORTH 811 JEFFERSON / SPOKANE,WASHINGTON 99260 / (509)456-3675
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
JOB ADDRESS
1. E. 12123 21st LEPAL DESCRIPTION — SEE ATTACHED 0 4 * * 1 7 0 0
LOT BLOCK SUBDIVISION PARCEL NUMBER/S F.
* 1 7.00 us
2.
OWNER PHONE * 1 7.0 0 6
3 Dave Bouge 928-6108 r,
ADDRESS ZIP Actual Set Backs in Feet p * 0. 0C
E. 12123 21st - Spokane, WA 99206 North 'South East (West 4. 4.0 .
CONTRACTOR PHONE Size of Parcel Zone Classification
4 Valley Fireplace, Inc. 922-2780 1 0-0 8-8 1
ADDRESSZ P Type Const. Occupancy Sprinklered
E. 16610 Sprague Ave. - Veradale, WA 037 Oyes ❑No 0 Req'd. 6 4 7 9
99
DESIGNER PHONE Valuation Building Area in Sq. Ft.
Contractor Specialty
5' ADDRESS No. VA LL EF 626 01N
ZIP Main Floor Upper Floors Garage Area Storage _
CHANGE OF USE FROM TO Area of Decks Finished Basement Unfin. Basement
6.
TYPENo. Baths No. Stories No. Rooms No. of Dwellings
0 NEW 0 ALT. 0 AD'N. 0 RPL. 0 MVE.
7. OF 0 OTHER
WORK 0 BLD. 0 PLMB. 0 MECH. 0 M.H. 0 POOL CERTIFICATE Req'd. Rec'd. Not Req'd.
of EXEMPTION
DESCRIBE WORK Enum.Dist. Location (Area)
8. Install Blaze King stove w pre-fab chimney. FEES COLLECTED
VALUATION SOURCE GAS ELECTRIC WATER SEWER Ownership USE CODE
OF
9. UTI LLITI ES Public 0 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 INSPECTION Plumbing
lr3
DATE OF APPLICATION
Z7—Al j SIGNATURE OF APPLICANT ; � Mech. ��` �
SPECIAL APPROVALS SPECIAL CONDITIONS: /
NAME DATE Plan Check
Env. Health Ready now for inspection.
SEPA >
Planning O
U
Fire Marshall Mobile Home _ w
1
Co. Engineer Other(Specify)
Utilities ^�
TOTAL $ 1700
Plans Examiner
WHEN MACHINE VALIDATED IN THIS SPACE,
SEPA Checklist THIS BECOMES A PERMIT.
Building Technician PERMIT IS NONTRANSFERABLE 1{),^0`8-r 8.1 4 41 z *1
7.0 0 RI--1 _
PO''- c)'1J- PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE DATE ISSUED PERMIT NO. TOTAL