1983, 08-03 Permit: 83A-7313 Wood StovePLAN NUMBER
c
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.
LOT BLOCK
2.
SUBDIVISION
OWNER
3.
Mg.ING DDRESS
Ncra
4.
ADDRESS
LICENSE EXPIRES
DESIGNER
5.
ADDRESS
CHANGE OF USE FROM
PHONE
PHONE
ZIP
PHONE
ZIP
TO
TYPE'NEW 0 ALT. ❑ A 'N. El RPL. 0 MVE.
7.WORK
P. ❑ PLMB. MECH. 0 M.H. 0 POOL OF El OTHER
PARCEL NO.
LEGAL DESCRIPTION:
Actual Set Backs in Feet to:
North (South lEast I West
Size of Parcel
Type Const.
Occupancy
New Const. Valuatlon
Main Floor
Zone Classification
Residential ❑
Commercial E
Spr nklered
0Yes ❑No ❑Req'd.
Remodeled Valuation
Upper Floors Garage/Storage
Cover Deck
No. Baths
Certifi. of Exempt.
or Variance
Uncv. Deck
No. Floors
DESCRIBr WOW96;1.2
VALUATION
9.
SOURCE
OF
UTILITIES
GAS
ELECTRIC
WATER
PUBLIC ❑
PRIVATE ❑
SEWAGE
SEPTIC 0
SEWER 0
Total Bldg. Floor Area
Greenhouse
Fin. Basement
No. Fin. Rooms
Required Yes Noll
Received Yes! Nol•
Unfin. Basement
No. Dwellings
Number
Shorelines/Flood Haza d Plans Required ❑
Yes:-' Not Applic. _: Received ❑
Ownership
Public L 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 al law regulating construction or the performance
of construction. SEE REVERSE SIDE FOR REOUI' 1 I IONS
OWNER OR AGENT SIGNATURE OF APPLICATION.
Wire DATE
SPECIAL APPROVA
PRELIM. FINAL
Env. Health
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
1
diky
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
Mech.
Plan Check
SEPA
Modular/
MFG. Home
Other (Specify)
TOTAL $
ZO-
P .J M T NUMBER
04* *2000
*2Q008
*000 8
A
731.2
08-03-83
2 6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATESVUEr 3, 8 5
173
PERM1 7NI '' Z
*2 a0 0 AL