1983, 02-23 Permit: 83A-1253 Wood StovePLAN 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. N 2�
LOT BLOCK
2.
SUBDIVISION t
3
OWNER
rJPC AFo
MAILING ADDRESS
rev. KJ5 -N1
CONTRACTOR
4.
ADDRESS
DESIGNER
ADDRESS
PHON
I 57+z
LICENSE EXPIRES
PHONE
456 -45-
PARCEL NO.
LEGAL DESCRIPTION:
PHONE
Actual Set Backs in Feet to:
North i South [East I West
Size of Parcel
Zone Classification
ZIP
PHONE
ZIP
Type Const.
Occupancy
New Const. Valuation
Residential ❑
Commercial ❑
Sprinklered
❑Yes 0 N ❑Req'd.
Remodeled Valuation
Total Bldg. Floor Area
Main Floor
Upper Floors
Garage /Storage
Greenhouse
CHANGE OF USE FROM
TO
TYPE Z"NEW ❑ ALT. 0,D' N. ❑ RPL. ❑ MVE.
7. OF ❑ OTHER
WORK ❑ BLD. ❑ PLMB. ZMECH. ❑ M.H. ❑ POOL
DESCRIBE WORK
8. VALUATION SOURCE
UTILITIES
9.
J5,
IAS
4 kO T7
ELECTRIC WATER
PUBLIC ❑
PRIVATE ❑
SEWAGE
SEPTIC ❑
SEWER ❑
No. Baths
Certif1. of Exempt.
or Variance
Uncv. Deck
No. Floors
Shorelines /Flood Hazard
Yes❑ Not Applic. ❑
Ownership
Public ❑ Private ❑
Fin. Basement
No. Fin. Rooms
Unfin. Basement
No. Dwellings
Required Yes No❑ Number
Received Yes❑ No❑
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 provision of any other state or local law regulating construction or the performance
of construction. E REVERSE SIDE1FOR QUIRED INSPECTI • S
SIGNATURE OF ��` APPLICATI
OWNER OR AGER � ka ∎:. >•l� DATE
SPECIAL APPROVALS
PRELIM. FINAL DATE
Env. Health
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
Plans Required ❑
Received ❑
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)
,3C
_7O
TOTAL $
PERMIT MBER
04* *30.00
*30.00
A *0.00 8
1252E
02 -23 -83
3 6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATE FSZ ED2 3 -8 3
PERMIT L a �' 3 z
* 3 Li, U .f . L