1984, 01-17 Permit App: 84A-482 Insert'5rVnA1MC UUUN I T — 1JCF0AK I MIN I Vr tfUILL)INU & JArt I Y
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES —PRESS HARD TO MAKE 3 COPIES
STREET ADDRESS PARCEL N0.
1' i�. 11516 - 48th
LOT BLOCK SUBDIVISION LEGAL DESCRIPTION:
2.
OWNER
PHONE
PHONE
3
Jeff ''Jarren
926-9089
MAILING ADDRESS
ZIP
Actual Set Backs in
1
Feet to:
El. 11516 - 48th
Spokane VIA
99206
North
south East West
CONTRACTOR
LICENSE EXPIRES
PHONESize
of Parcel
Zone Classification
Residential El
4
1/1/84
922-2780
1 1
Commercial ❑
ADDRESS
ZIP
Type Const.
Occupancy
Sprinklered
E. 16610 Sprague
Ave. Veradale li''IA
99037
°Yes [:]No
❑Req'd.
DESIGNER
PHONE
New Const. Valuation
Remodeled Valuation
Total Bldg. Floor Area
5
Contr. License
ALLF-177CG
ADDRESS
ZIP
Main Floor
Upper Floors i
Garage/Storage Greenhouse
CHANGE OF USE FROM
TO
Cover Deck
Uncv, Deck
I Fin, Basement
Unfin. Basement
6.
Baths
No. Floors
No. Fin. Rooms
No. Dwellings
TYPE /NEW El ALT. 11 AD'N. El RPL. D MVE.No.
7.
OFI
WORK 11BLD. ElPLMB., 'MECH. 1-1M.H. ❑ POOL 1-1 OTHER
Certlfl.ofExempt.
Required Yes 1-1 No 71
Number
or Variance Received Yes C] No F]
DESCRIBE WORK Shorelines/Flood Hazard Plans Required ❑
8• Installation of LX LOPI Insert into fire lace. Yes Ll Not Applic. ❑ Received ❑
VALUATION SOOUFCE GAS ELECTRIC WATER PUBLIC ❑ SEPT CG❑ Ownership FEES COLLECTED
9 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 SIRE FOR REQUIRED MSPECTIONS
SIGNATURE OF APPLICATION
OWNER OR AGENT DATE �
SPECIAL APPROVALS SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PRELIM. FINAL DATE
Env. Health
Planning
Fire
Plans i i i I PERMIT IS NONTRANSFERABLE
Exam. PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
Building IN 180 DAYS
Tech. I Zffl I IA
Building
Plumbing
Mech.
Plan Check
SEPA
Modular/
MFG. Home
Other (Specify)
0
10
TOTAL $ ''s
WHEN MACHINE VALIDAT
THIS BECOMES A PERMIT.
DATE "LfbL /
PERMIT NO? 8, 3 z * 2 G. 0 0 pO1J-AL
CL
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C.3
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