1983, 12-19 Permit: 83B-2611 Wood Stove, ChimneyPLAN 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
STREEJ ADDRESS
1. ti . 19-0C) 1
LOT BLOCK SUBDIVISION
2.
PARCEL NO.
OV✓ ER
3.
MAII,INGApDREIS
CONTRAnTO
4.
ADDRESS
DESIGNER
5.
ADDRESS
6.
a ONE
PHONE
LEGAL DESCRIPTION:
LICENSE EXPIRES PHONE
CHANGE OF USE FROM
TO
ZIP
PHONE
ZIP
TYPE ZW ❑ ALT. ❑ AD' N. ❑ RPL. ❑ MVE.
7. OF ❑ OTHER
WORK ❑ BLD. ❑ PLMB. eMECH. ❑ M.H. El POOL
8. DESCFyBBEK ),
VALUATION SOURCE GAS ELECTRIC WATER
9.
UTILITIES PUBLIC RIVA E ❑
Actual Set Backs in Feet to:
North I South I East I West
Zone Classification
Size of Parcel
Type Const.
Occupancy
Residential 0
Commercial 0
Sprinklered
❑Yes ❑No ❑Req'd.
New Const. Valuation
Remode ed Valuation
Total Bldg. Floor Area
Main Floor
Cover Deck
Upper Floors I Garage /Storage
Uncv. Deck
No. Baths
No. Floors
Certif1. of Exempt.
or Variance
Greenhouse
Fin. Basement
No. Fin. Rooms
Required Yes No❑
Received Yes❑ No El
Unfin. Basement
No. Dwellings
Number
Shorelines /Flood Hazard
Yes❑ NotApplic. ❑
SEWAGE
SEPTIC ❑
SEWER ❑
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 other state or local law regulating construction or the performance
of construction. SEE REVERSE SIDE FOR REQUIRED INSPECTIONS
OWNER ORE GENT a X�— c...I���vrz APPLICATION Z /`�
SPECIAL APPROVALS SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE) �/G�
PRELIM. FINAL DATE
Env. Health
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
r
PERMIT IS NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
Plans Required ❑
Received ❑
FEES COLLECTED
Building
Plumbing
Mech.
Plan Check
SEPA
Modular/
MFG. Home
Other (Specify)
TOTAL
0
PERMIT NUMBER
*3000
*30:006
*000
61.0g.
12 -19 -83
6/179.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
12 -19 -8
DATE ISSUED
261,12 *30.0021-
PERMIT NO. TOTAL