1983, 01-31 Permit: 83A-719 Wood StovePLAN NUMBER
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APPLICPTION/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
1.
2.
STREET ADDRESS
LOT BLOCK
PARCEL NO.
,r . --0 04
SUBDIVISION
OWNER
3 t e_
MAILING ADDRESS
(4. Ce" -C. `; azo AC*
4.
5.
CONTRACTOR
p v'tf'`,
ADDRESS
DESIGNER
PHONE
PHONE
a�4 1t8
LEGAL DESCRIPTION:
LICENSE EXPIRES
ZIP
olq
PHONE
ZIP
ADDRESS
CHANGE OF USE FROM
6.
PHONE
ZIP
TO
TYPE k7 NEW ❑ ALT. ❑ AD' N. ❑ RPL. ❑ MVE. OTHER
7. OF
WORK ❑ BLD. ❑ PLMB. T'-MECH. ❑ M.H. ❑ POOL
Actual Set Backs in Feet to:
North ISouth
Size of Parcel
[East l West
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
Garage/Storage
Total Bldg. Floor Area
Greenhouse
Uncv. Deck
Fin. Basement
Unfin. Basement
No. Baths
No. Floors
No. Fin. Rooms
No. Dwellings
Certif1. of Exempt.
or Variance
Required Yes No❑
Received Yes ❑ No
8.
9.
DESCRIBE WORK
VALUATION
SOURCE
OF
UTILITIES
11-1 itV11C&C.y CtiInn IVE'f
WATER
PUBLIC ❑
PRIVATE ❑
GAS
ELECTRIC
SEWAGE
SEPTIC ❑
SEWER 0
Shorelines/Flood Hazard
Yes Not Applic. ❑
Ownership
Public 0 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 REVERS SID FOR EQUIF D INSPECTIONS
SIGNATURE OF
OWNER OR AGENT
SPECIAL_ APPROVALS
PRELIM. FINAL DATE
Env. Health
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
APPLICATIQ44 J — I
DATE
SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PERMIT IS NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCEC
IN 180 DAYS
Number
Plans Required ❑
Received ❑
FEES COLLECTED
Building
Plumbing
Mech.
Plan Check
SEPA
Modular/
MFG. Home
Other (Specify)
TOTAL $13_"_)
PERMIT NUMBER
Q4* *3000
*30,006
A *000
71,82
01-31-83
6479,
FllFtflPY
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATE ►S3t1ED3 1 _ 8 3
PERMIT NO. 1 9 z
*30.(30 ,tAL