1984, 01-09 Permit: 844-208 FireplacePLAN NUMBER APPLICATION/PERMIT
SPOKANE COUNTY — DEPA9TMENT OF BUILDING & SAFETY
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
STREET ADDRESS PARCEL NO.
2.
Lor[_ff�711DIVISION LEGAL DESCRIPTION:
OWNER PHONE PHONE
3. .._. t t /V,_ 6
MAILING ADDRESS ZIP Actual Set Backs in Feet to:
North South East West
CONTRACTOR
- 4
LICENSE EXPIRES
PHONE
Size of Parcel
Zone Classmcation
Residential C
Commercial ❑
4.T
ADDRESS
ZIP
Type Const.
Occupancy
Sprinklered
c�3
❑Yes []No ❑Req'd.
DESIGNER
PHONE
New Const. Valuation
Remodeled Valuation
Total Bldg. Floor Area
5.
ADDRESS
ZIP
Main Floor Upper
Floors
Garage/Storage
Greenhouse
CHANGE OF USE FROM
TO
Cover Deck
Uncv. Deck
Fin. Basement
Unfin. Basement
6.
No. Baths No.
Floors
No. Fin. Rooms
No. Dwellings
PE EW ElALT. ❑ AQ'N. El RPL. 1:1MVE.
!• OF El OTHER
WORK ❑ BLD. ❑ PLMB. ECH. El M.H. 171 POOL
Certifi.ofExempt.
Required
Yes❑ No—
Number
or Variance
Received
Yes NOF!
DESCRIBE WORK
8
Shorelines/ Flood Hazard
Plans Required EJ
t✓��i1 �Yv����
Yes C Not Applic.❑
Received ❑
VALUATION
50OFCE
GAS
ELECTRIC
PUBLIC WATER
SEWAGE
SEPTIC C
Ownership
FEES COLLECTED
9
UTILITIES
PRIVATE r
I SEWER ❑
Public ❑ 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 INSPECTIONS
Plumbing
SIGNATURE OF APPLICATION
OWNER OR AGENT �'%�L�a DATE
Mech.
,�` -�
SPECIAL APPROVALS SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PRELIM. FINAL DATE -•C [Z.,c-, r-'_7
Env. Health �(
Planning
Prevent.
Utilities
Plans i i i I PERMIT IS NONTRANSFERABLE
Exam. PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
Tech ing IN 180 DAYS
Plan Check
SEPA
Modular/
MFG. Home
Other (Specify)
PE MIT NUMBER
q-rq •- Z�ag
Zv']
TOTAL $ '
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES AR PERMIT.
DATEWS9UEDo , '_ PERMIT NCO• 8 z
* 2 0. 0 0 110irAL
Y
a
O
C.7
W
J
LL