1983, 08-02 Permit: 83A-7304 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. \),
LOT
2.
BLOCK
SUBDIVISION
OWNER
3. r -t5ton)
MAILING ADDRESS
4.
CONTRACTOR
ADDRESS
fa re
PHONE
LICENSE EXPIRES
PHONE
PARCEL NO.
LEGAL DESCRIPTION:
5.
DESIGNER
ADDRESS
CHANGE OF USE FROM
•
ZIP
PHONE
ZIP
PHONE
ZIP
TO
TYPE /NEW ❑ ALT. ❑ D' N. 0 RPL. 0 MVE.
7.
❑OTHER
WORK ❑ BLD. 0 PLMB. MECH. 0 M.H. ❑ POOL
Actual Set Backs in Feet to:
North !South [East I West
Size of Parcel
Zone Classification
Residential 0
Commercial 0
Spr nklered
Yes 0No UReq'd.
Remode ed Valuation
Main Floor tipper Floors Garage/Storage
Cover Deck
No. Baths
Certifi. of Exempt.
or Variance
Uncv. Deck
No. Floors
Total Bldg. Floor Area
G eenhouse
Fin. Basement
No. Fin. Rooms
Unfin. Basement
No. Dwellings
Required Yes= Nor= Number
Received Yes .0 Nor-
DESCRIBE
oi
DESCRIBE WORK
L-14fir17.:'"rt,C
9. VALUATION
SOURCE
F
UTILITIES
GAS
ELECTRIC
WATER
PUBLIC 0
PRIVATE Cl
SEWAGE
SEPTIC 0
SEWER 0
Shorelines/ Flood Hazard
YesLJ Not Applic. 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 INSPECTIONS
SIGNATURE OF APPLICATION
49— z _83
OWNER OR AGENTS DATE 4.
SPECIAL,APPROVA SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PRELIM. FINAL DATE
Env. Health
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam
Building
Tech.
PERMIT IS NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
Plans Required 0
Received
FEES COLLECTED
Building
Plumbing
Mech,
Plan Check
SEPA
Modular/
MFG. Home
Other (Specify)
3J -2),(1.-C.)
TOTAL $ "..241>, cc?
PERMIT NUMBER
55 4— 7".c=1.-
04
$
04
7302
*2.00
08 12-83
64 9.
04* *2000
730.3
08-02-83
6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
08.0.2-83 730,42 *2aoOa�
DATE ISSUED PERMIT NO. TOTAL