1983, 05-10 Permit: 83A-3852 Cook Top InsertPLAN NUMBER
v
APPLICATION/PERMIT
SPOKANE COUNTY - DEPARTMENT OF BUILDING & SAFETY
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
2.
APPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 3 COPIES
STREET ADDRESS
LOT
BLOCK
SUBDIVISION
3. 77,51A FA kWOLZ
MAILING ADDRESS
P O E PHONE
PARCEL NO.
LEGAL DESCRIPTION:
CONTRA OR
4.
ADDRESS
LICENSE EXPIRES PHONE
ZIP
DESIGNER PHONE
5.
ADDRESS
CHANGE OF USE FROM
6.
ZIP
TO
TYPE NEW ❑ ALT. ❑ AD' N. ❑ RPL. D MVE.
7. OF WORK ❑ BLD. ❑ PLMB.�E'SMECH. ❑ M.H. ❑ POOL ❑OTHER
Actual Set Backs in Feet to:
North (South LEast 1 West
Size of Parcel I Zone Classification
Residential ❑
Commercial D
Type Const.
Occupancy Spr nklered
❑Yes DNo Req 'd.
New Const. Valuation
Main Floor
Remode ed Valuation
Upper Floors Garage/Storage
Cover Deck
Uncv. Deck
No. Baths
No. Floors
Total Bldg. Floor Area
Greenhouse
Fin. Basement
No. Fin. Rooms
Unf in. Basement
No. Dwellings
Certifi. of Exempt.
or Variance
Required Yes'E No%:
Received Yes No
Number
DESCRIBE WORK
8.
Shorelines/Flood Hazard
Yes❑ Not Applic. ❑
VALUATION
9.
SOURCE
F
UTILITIES
GAS 1 ELECTRIC
WATER
PUBLIC ❑
PRIVATE O
SEWAGE
SEPTIC D
SEWER 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 performance
of construction. SEE REVERSE SIDE FOR REQUIRED INSPECT!' NS
SIGNATURE OF
OWNER OR AGENT
SPECIAL AI'tPROVALS
PRELIM. FINAL DATE
Env. Health
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
APPLICATION
DATE �//G'/S3
SPECIAL CONDITIONS: (S E REVERSE SIDE FOR NOTICE)
PERMIT IS NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
Plans Required D
Received ❑
FEES COLLECTED
Building
Plumbing
Mech.
Plan Check
SEPA
Modular/
MFG. Horne
Other (Specify)
Z
Ji
TOTAL $ -7--C7
PERMITNUM R
-
04* *2Q00
*20.006
A *0.00 8
385.1g
05-10-83
g 6479.
Ct.
C
C)
W
J
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATEYSSUED1 O - 8 3
PERMIT 4& 5. 2 z
* 0.0 0ti1OVAL