1983, 04-06 Permit 83A-2450 Fireplace FurnacePLAN NUMBER
APPLICATION/PERMIT
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
1.
:17.z 1'`;r' ,,1"Ii 5104 _, . Felts
PARCEL NO.
LOT BLOCK
2.
SUBDIVISION
3.
4.
OWNER
PHONE
PHONE
LEGAL DESCRIPTION:
MAILING ADDRESS
5104 S. Felts
CONTRACTOR valley Fireplace
LIOE14SiEi1 I RES
ZIP
PJolf-27 0
Actual Set Backs in Feet to:
North lSouth ]East I West
Size of Parcel 1 Zone Classification
Residential ❑
Commercial ❑
ADDRESS
DESIGNER
5.
ADDRESS
10610 Born,:-.: ava.
or , i.`..
ontr. . L. oris e •
ZIP :oo�i'
Type Const.
Occupancy
Spr'nklered
❑Yes ❑No ❑Req'd.
PH�tf�
New Const. Valuation
Remodeled Valuation
Total Bldg. Floor Area
ZIP
Main Floor
Upper Floors
Garage/Storage
Greenhouse
6.
CHANGE OF USE FROM
TO
Cover Deck
Uncv. Deck
Fin. Basement
Unfin. Basement
TYPE 0 NEW 0 ALT. 0 AD'N. 0 RPL. ❑ MVE.
7. OF 0 BLD. ❑ PLMB. ❑ MECH. 0 M.H. 0 POOL
WORK
❑ OTHER
No. Baths
No. Floors
No. Fin. Rooms
No. Dwellings
Certifi. of Exempt.
or Variance
Required Yes No❑
Received Yes0 No0
Number
8.
9.
DESCRIBE WORK-ilstall L . Lopt 1':ire lace
S 7? rZ fireplao ,
VALUATION
SOURCE
F
UTILLIITIES
GAS
ELECTRIC
i,'urnaoe iri
WATER
PUBLIC 0
PRIVATE 0
SEWAGE
SEPTIC 0
SEWER 0
Shorelines/Flood Hazard Plans Requ red 0
Yes❑ NotApplic. 0 Received 0
Ownership
Public 0 Private 0
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 per ormance
of construction. SEE REVERSE SIDE FOR REQUIRED INSPECTIONS���
SIGNATURE OF , ' �(•l/TC.-�t'-'29 DATE
APPLICATION
OWNER OR AGENT ��� tilt ��'�-(Z�
SPECIAL APPROVALS SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PRELIM. FINAL DATE
Env. Health
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
PERMIT IS NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
FEES COLLECTED
Building
Plumbing
Mech.
Plan Check
SEPA
Modular/
MFG. Home
Other (Specify)
TOTAL $
PEEWIT NUMBER
04* *20.00
*20.006
A *0.00 a
244,9g
03-31-83
6479,
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATEgSSUEt7 1 — o+' 3 PERMI416. 5, 0 5 * 2 O. 0 0 iaim.