1984, 04-02 Permit: 84A-2811 InsertPLAN NUMBER
APPLICATION /PERMIT PERMIT NUMBER
No. Floors
No. Fin. Rooms
No. Dwellings
TYPE 1:1NEW C]ALT. ElAD'N. ❑ RPL. ElMVE.
SPOKANE COUNTY - DEPARTMENT 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.
Required Yes❑ NOD
E. 10911 35th Ave.
WORK ❑ BLD. ❑ PLMB. ❑ MECH. ❑ M.H. ❑ POOL
LOT
BLOCK
SUBDIVISION
DESCRIBE WORK
LE AL DES RIPTION:
Plans Required ❑
2.
yes[] Not Applic. ❑
I
I
SOURCE
OF
OF
GAS
ELECTRIC
OWNER
SEWAGE
SEPTIC ❑
P9�NI 3809
M38093.
FEES COLLECTED
Robert Kirk
I
PRIVATE El
SEWER ❑
MAILING ADDRESS
ZIP
Actual Set Backs In Feet to:
reverse side, and know the same to be true and correct. All provisions of laws and ordinances governing this type of
E. 10911 35th
Ave.
North South East West
of construction. SEE REVS E SI E FOR REO RED I SPEC IONS
CONTRACTOR
SIGNATURE OF APPLICATION
'A L�1 3
LICENSE EXPIRES
PHONE
Size of Parcel
Zone Classification
Residential ❑
Valley F' 9 a 6
_
Commercial El4.
ADDRESS
ZIP
Type Const.
Occupancy
Sprinklered
r;. 16610 S ra Ue Ave.
Veradale PYA
99037
Dyes ONO ❑Req'd.
_.
DESIGNER
PHONE
New Const. Valuation
Remodeled Valuation
Total Bldg. Floor Area
5
Contr. License VALLt:F-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.
PRELIM. FINAL DATE
Env. Health
Planning
Utilities
Plans
Exam.
�Z
PERMIT IS NONTRANSFERABLE
PERMIT IS NULLAND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
SEPA
Modular/
MFG. Home
Other (Specify)
TOTAL $
WHEN MACHINE VALIDATED IN THIS SPACE
THIS BECOMES A PERMIT. 1
I i' 2— 4 L 1. 1 z
DAT PERMI -
z
*20.00°�'_
TOTAL
n n
* rt _V, LJ a
CL
O
V
W
J
LL.
No. Baths
No. Floors
No. Fin. Rooms
No. Dwellings
TYPE 1:1NEW C]ALT. ElAD'N. ❑ RPL. ElMVE.
7, OF E3 OTHER
Certfifaof empt.
Required Yes❑ NOD
Number
WORK ❑ BLD. ❑ PLMB. ❑ MECH. ❑ M.H. ❑ POOL
Received Yes❑ NOD
DESCRIBE WORK
Shorelines/ Flood Hazard
Plans Required ❑
8• Installation of Convector 31 Insert in fireplace.
yes[] Not Applic. ❑
Received ❑
VALUATION
SOURCE
OF
OF
GAS
ELECTRIC
WATER
PUBLIC ❑
SEWAGE
SEPTIC ❑
Ownership
FEES COLLECTED
9
I
PRIVATE El
SEWER ❑
public ❑ Private ❑
1 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 REVS E SI E FOR REO RED I SPEC IONS
plumbing
SIGNATURE OF APPLICATION
'A L�1 3
OWNER OR AGENT -Z DATE
Mach. .L�
SPECIAL APPROVALS
SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
Plan Check
PRELIM. FINAL DATE
Env. Health
Planning
Utilities
Plans
Exam.
�Z
PERMIT IS NONTRANSFERABLE
PERMIT IS NULLAND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
SEPA
Modular/
MFG. Home
Other (Specify)
TOTAL $
WHEN MACHINE VALIDATED IN THIS SPACE
THIS BECOMES A PERMIT. 1
I i' 2— 4 L 1. 1 z
DAT PERMI -
z
*20.00°�'_
TOTAL
n n
* rt _V, LJ a
CL
O
V
W
J
LL.