1983, 10-04 Permit: 83A-9911 Wood Stove1
PLAN NUMBER
G
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.
P:cA, C
LOT
2.
BLOCK SUBDIVISION
OWNER
3 MAILING ADDRESS
PHONE
PHONE
PARCEL NO.
LEGAL DESCRIPTION:
4.
CONTRACTOR
ADDRESS
Atnti.E
DESIGNER
LICENSE EXPIRES
ADDRESS
CHANGE OF USE FROM
ZIP Actual Set Backs in Feet to:
-0-4C North South [East West
PHONE
ZIP
PHONE
ZIP
TO
TYPE G✓ NEW ❑ ALT. ❑ D' N. ❑ RPL. El MVE.
7. OF ❑ OTHER
WORK ❑ BLD. ❑ PLMB. MECH. ❑ M.H. ❑ POOL
Size of Parcel
Zone Classification
Type Const.
Occupancy
Residential 0
Commercial
Sprinklered
❑Yes 0 N Req 'd.
New Const. Valuation I Remodeled Valuation
Main Floor
Cover Deck
Upper Floors
No. Baths
Certifi. of Exempt.
or Variance
Uncv. Deck
Total Bldg. Floor Area
Garage/Storage
No. Floors
Fin. Basement
Greenhouse
Unfin. Basement
No. Fin. Rooms
No. Dwellings
Required Yes❑ No
Received Yes❑ NoE
Number
DESCRIBE WORK
8. t,.,)C:a9T® G
VALUATION
9.
SOURCE
OF
UTILITIES
GAS
ELECTRIC
WATER
PUBLIC ❑
PRIVATE ❑
SEWAGE
SEPTIC ❑
SEWER ❑
Shorelines/Flood Hazard Plans Required ❑
Yes ❑ NotApplic. ❑ Received ❑
Ownership
Public ❑ Private ❑
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 6
OWNER OR AGENT �u
t1
APPLICATION
DATE C 0— y— 8 3
SPECIAL APPROVALS
PRELIM. FINAL DATE
Env. Health
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
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 $-2..0, Cb
PERMIT NUMBER
C 4i 1,4
04* *20.00
*20.006
A *0,00 8
991.027
10-04-83
} 6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATE PS4JED0 4 - 8 3
PERMITL2 1, 1 z
*2 a,00'mtAL