1983, 09-22 Permit: 83A-9393 FireplacePLAN NUMBER APPL ICAT ION /PERMIT
SPOKANE COUNTY - DEPARTMENTPF 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.
1. G 109-2,
LOT
�C0�i
LOT BL CK SUBDIVISION LEGAL DESCRIPTION:
2.
SPECIAL APPROVALS SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PRELIM. FINAL DATE
Env. Health
Planning
Prevent.
Engineer
Utilities
Plans — PERMIT IS NONTRANSFERABLE
Exam. PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
Tech mg IN 180 DAYS
Plan Check
SEPA
Modular/
MFG. Home
Other (Specify)
PE MIT, NUMBER
TOTAL $
WHEN MACHINE VALIDATED IN THIS SP
THIS BECOMES A PERMIT.
DATE ISSOED 2 2 —8 5 PERMIT NO � 9' 3 C * 2 0' 0 "raTki.
OWNER
I RHONE
PHONE
3.
MAILING A DR SS
Actual Set Backs in Feet to:
•
�}
I '
North South East
West
CONTRACT08—
LICENSE EXPIRES
P NE
Size of Parcel
Zone Classification
Residential
Commercial ❑
4.
ADDRESS
ZIP
Type Const. Occupancy
Sprinklered
❑Yes ONO ❑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
s.
No. Baths No.
Floors
No. Fin. Rooms
No. Dwellings
TYPE 0 NEW ❑ ALT. DAWN. ❑ RPL.
[I MVE.
7.
OF -�/�
B. �'ECH. ❑ M.H.
YIELD. ❑ PLMNI
El OTHER
❑POOL
Certifi. of Exempt.
Required
Yes El No❑
Number
WORK
or Variance
Received
Yes❑ No❑
8.
DESC ISE V1(ORK I ®
Hazard
Plans Required ❑
Yes❑ Not Applic. ❑
YesDShorelines/ of A
Received ❑
'9
VAL TION
SOURCE
OF
G
S ELECTRIC
WATER
PUBLIC ❑
SEWAGE
SEPTIC ❑
Ownership
FEES COLLECTED
UTILITIES
PRIVATE ❑
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
W'
work will be complied with whether specified herein or
not. The granting of a permit does not presume to give au-
Building
thority to violate or cancel the provisions of any other state or local law regulating construction or the performance
of construction. SEE REVERSE SIDE FO EOUIRED INSPECTIONS
SIGNATURE OFAPPLICATION +� l
�
Plumbing
OWNER OR AGENT L
DATE tT
Mach.
SPECIAL APPROVALS SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PRELIM. FINAL DATE
Env. Health
Planning
Prevent.
Engineer
Utilities
Plans — PERMIT IS NONTRANSFERABLE
Exam. PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
Tech mg IN 180 DAYS
Plan Check
SEPA
Modular/
MFG. Home
Other (Specify)
PE MIT, NUMBER
TOTAL $
WHEN MACHINE VALIDATED IN THIS SP
THIS BECOMES A PERMIT.
DATE ISSOED 2 2 —8 5 PERMIT NO � 9' 3 C * 2 0' 0 "raTki.