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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