1983, 12-19 Permit: 83B-2624 InsertPLAN NUMBER
APPLICATION/PERMIT PERMIT NUMBER
SPOKANE COUNTY - DEPARTMENT OF BUILDING & SAFETY ?3B -
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
STREET ADDRESS PARCEL NO.
E. 12804 - 29th `
1
WA
LICE
1
) Ave. Veradale
PHONE
ZIP Actual Set Backs in Feet to:
99216 North South East West
PHONE Size of Parcel Zone Classification Residential ❑
922-2780 1 1 Commercial ❑
ZIP Type Const. Occupancy Sprinklered
99037 ❑Yes ONO ❑Req'd.
PHONE New Const. Valuation Remodeled Valuation Total Bldg. Floor Area
ZIP Main Floor I Upper Floors Garage/ Storage Greenhouse
s. CHANGE OF USE FROM TO Cover Deck Uncv. Deck Fin. Basement Unfin. Basement
TYPEINEW El ALT. ❑ AD' N. El RPL.
S
LOT
BLOCK
2.
No. Floors
I
No. Fin. Rooms
OWNER
3.
Mr . or Mrs
❑OTHER
MAILING ADDRESS
E. 12804 -
CONTRACTOR
4
Valley Fir
ADDRESS
E. 16610 Si
Number
DESIGNER
5
Contr. Lici
or variance
ADDRESS
1
WA
LICE
1
) Ave. Veradale
PHONE
ZIP Actual Set Backs in Feet to:
99216 North South East West
PHONE Size of Parcel Zone Classification Residential ❑
922-2780 1 1 Commercial ❑
ZIP Type Const. Occupancy Sprinklered
99037 ❑Yes ONO ❑Req'd.
PHONE New Const. Valuation Remodeled Valuation Total Bldg. Floor Area
ZIP Main Floor I Upper Floors Garage/ Storage Greenhouse
s. CHANGE OF USE FROM TO Cover Deck Uncv. Deck Fin. Basement Unfin. Basement
TYPEINEW El ALT. ❑ AD' N. El RPL.
S
❑ MVE.
No. Baths
No. Floors
No. Fin. Rooms
No. Dwellings
7
❑OTHER
WORK El BLD. ❑ PLMB.,�MECH. 13M.H.
11 POOL
Certifi.ofExempt.
Required Yes❑ NOD
Number
or variance
Received Yes❑ No❑
DESCRIBE WORK
8.
Shorelines/ Flood Hazard
Plans Required ❑
Installation of Blaze Princess Stove
Model
PTJ.
Yes❑ Not Applic. ❑
Received ❑
VALUATION
Q
SOURCE
OF
GAS
ELECTRIC
WATER
PUBLIC 1:1SEPTIC
SEWAGE
❑
Ownership
FEES COLLECTED
UTILITIES PRIVATE ❑ 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
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 SIGAE FOR REQUIRED 4INSPECTIONS
SIGNATURE OF :DATE
PPLICATION
OWNER OR AGENT
SPECIAL APPROVALS SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PRELIM. FINAL DATE
Env. Health
Planning
Prevent.
Utilities
Plans PERMIT IS NONTRANSFERABLE
Exam.A PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
Building Tech. Vy IIN 180 DAYS
/�
Building
Plumbing
0�
Mach.
Plan Check
SEPA
Modular/
MFG.Home
Other (Specify)
ai
TOTAL $
WHEN MACHINE VALIDATED IN
THIS BECOMES A PERMIT.
DATEISSUED� 7 5 PERMITU. 2. 4 z * 2 U. 0 0 0 -j
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