1983, 11-15 Permit App: 83B-1658 Wood Stove, ChimneyLEGAL DESCRIPTION:
PLAN 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
ST EETADDRESS
1./Vgo9
LOT BLOCK
2.
SUBDIVISION
NER
3 G tui b -7-74/9.
.
MAILING ADDRESS
CONTRACTOR
4. ADDRESS
P ONE
11- ,z 2 P ;--
PHONE
DESIGNER
5. ADDRESS
CHANGE OF USE FROM
LICENSE EXPIRES
ZIPS, y 2 /6,
PARCEL NO.
PHONE
ZIP
PHONE
ZIP
TO
TYPE •EW ❑ ALT. ❑ AD' N. ❑ RPL. ❑ MVE. ❑OTHER
7. OF ❑ BLD. ❑ PLMB. MECH. ❑ M.H. ❑ POOL
WORK
Actual Set Backs in Feet to:
North South
Size of Parcel
DESCRIBE WORK
. v t' .s rCYE. ,MS r4 TTON o11atix�rdfLY tifMNk Y
VALUATION
9.
SOURCE WATER SEWAGE
PUBLIC 17 SEPTIC ❑
UTILLIITIES PRIVATE ❑ SEWER ❑
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 REV SE SIDE FOR REQUIRED INSPECTIONS
GAS
ELECTRIC
Cover Deck
No. Baths
East
West
Zone Classification
Residential ❑
Commercial ❑
Spr'nklered
OYes ONo ❑Req'd.
Remodeled Valuation
No. Floors
Total Bldg. Floor Area
Greenhouse
Fin. Basement
No. Fin. Rooms
Required Yes❑ No❑
Received Vest: No Pi
Shorelines /Flood Hazard
Yes❑ Not Applic. ❑
Ownership
Public ❑ Private ❑
SIGNATURE OF
OWNER OR AGENT
APPLICATION L/
DATE /I — l7 P
Unfin. Basement
No. Dwellings
Plans Required ❑
Received ❑
SPECIAL APPROVALS
PRELIM. FINAL DATE
Env. Health
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PERMIT IS NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
FEES COLLECTED
Building
Plumbing
()C
Mech.
Plan Check
SEPA
Modular/
MFG. Home
Other (Specify)
TOTAL $
00
10 1.5,
PERMIT NUMBER
*0000
*3000
*30006
*u00
1657!
11 -15 -83
6479,
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATE1 1 EDL 5 - 8
PERMIT]Ne. 5,8
*moo