1984, 01-11 Permit: 84A-280 Wood StovePLAN NUMBER
APPLICATION /PERMIT
SPOKANE COUNTY — DEPARTMENT OF BUILDING & SAFETY
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456 -3675
STREET ADDRESS /_rruot.IlT. oo*.IrLETE UP.IDEFW D Or`i1f & PARCEL I N D T.O MARC 0 oorsEo
1.
LOT
2.
1303 I P R-1)
BLOCK SUBDIVISION
OWNER
3 r1) frit4 . �N%
MAILING ADDRESS
5A1/1V
PHONE
czU -3O&
CONTRACTOR
4.
ADDRESS
LICENSE EXPIRES
DESIGNER
5.
ADDRESS
CHANGE OF USE FROM
6.
TO
PHONE
ZIP
PHONE
ZIP
PHONE
LEGAL DESCRIPTION:
Actual Set Backs in Feet to:
North South East I West
Size of Parcel
Type Const.
Occupancy
New Const. Valuation
Zone Classification
Residential ❑
Commercial ❑
Sprinklered
❑Yes ❑No ❑Req'd.
Remodeled Valuation
ZIP
Main Floor
Upper Floors Garage /Storage
TYPE ,,Q NEW ❑ ALT. ❑ AD' N. El RPL. ❑ MVE.
7. OF ❑ OTHER
WORK ❑ BLD. ❑ PLMB.7'MECH. ❑ M.H. ❑ POOL
8.
DESCRIBE WORK
VALUATION
9.
SOURCE
UTILITIES
GAS
ELECTRIC
WATER
PUBLIC ❑
PRIVATE ❑
SEWAGE
SEPTIC ❑
SEWER ❑
Cover Deck
Uncv. Deck
No. Baths
Certif1. of Exempt.
or Variance
No. Floors
Total Bldg. Floor Area
Greenhouse
Fin. Basement
No. Fin. Rooms
Required Yes❑ No❑
Received YesE Non
Shorelines /Flood Hazard
Yes❑ Not Applic. ❑
Ownership
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 her state or local law regulating construction or the performance
of construction. SEE R -, • RSE S ' E FO - RE ! . ED INSPECTIONS
SIGNATURE OFD ����� APPLICATION J
PRELIM. FINAL DATE
Planning
Fire
Prq..ont
Engineer
Utilities
SEPA
Plans
Building
Trh
E SIDE FOR NOTI E
r
PERMIT IS NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
Unfin. Basement
No. Dwellings
Number
Plans Required ❑
Received ❑
FEES COLLECTED
Building
Plumbing
Mech.
Plan Check
SEPA
Modular/
MFG. Home
Other (Specify)
TOTAL
41
PERMIT NUMBER 4
/1* *20.00
*20006
A *0.00
27.92
0.1 -11 -84
2 6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
01 -11 =84 28.05
*2 ;0.00 °I
DATE ISSUED PERMIT NO. TOTAL