1984, 04-04 Permit: 84A-2906 WoodstovePLAN 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. E.1'1_clt5
PARCEL NO.
LOT
2.
BLOCK
SUBDIVISION
OWNER
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PHONE
PHONE
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LEGAL DESCRIPTION:
MAILING ADDRESS
F . {2eA tS 11, :c -t
4.
CONTRACTOR
LICENSE EXPIRES
ADDRESS ADDRESS
jlkr��
5.
DESIGNER
ADDRESS
CHANGE OF USE FROM
6.
ZIP
PHONE
ZIP
PHONE
ZIP
TO
TYPE ft/NEW E ALT. ❑ AD' N. ❑ RPL. D MVE.
7. OFWORK Cl BLD. ❑ PLMB. E1"MECH. ❑ M.H. ❑ POOL ❑ OTHER
Actual Set Backs in Feet to:
North (South East I West
Size of Parcel Zone Classification
Type Const.
Occupancy
New Const. Valuation
Residential D.
Commercial LI -
Spr'nklered
❑Yes ❑No Req 'd.
Remodeled Valuation
Main Floor
Upper Floors
Cover Deck
No. Baths
Certifi. of Exempt.
or Variance
Garage/Storage
Total BIdg. Floor Area
Uncv. Deck
No. Floors
Fin. Basement
Greenhouse
No. Fin. Rooms
Unfin. Basement
No. Dwellings
Required Yes ❑ NoC Number
Received Yes No—'
DESCRIBE WORK
8. rli0o7`CDUE
Shorelines/ Flood Hazard
Yes EI Not Apollo. ❑
VALUATION
9.
SOURCE
F
UTILITIES
GAS l ELECTRIC
WATER
PUBLIC ❑
PRIVATE 0
SEWAGE
SEPTIC 0
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 ' IDE • R .• UIRED INSPECTIONS
SIGNATURE O /�. ' APPLICATION
OWNER ORA / �!� DATE /4i/TV
SPESIAL APP VALS
PRE FINAL DATE
Env. Health
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
vx,
SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PERMIT IS NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
Plans Required [l
Received ❑
FEES COLLECTED
Building
Plumbing
Mech.
Plan Check
SEPA
Modular/
MFG. Home
.ZC7-oo
Other (Specify)
TOTAL $ Z "zif5
PERMIT NUMBER
s4. A, -
04* *2000
29052
04-04-84
6470
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATE (SUED 0 4_ 8 4 PERMIT NO9 O. 6 5
*2 0, 0 OTOTAL