1983, 11-01 Permit: 83B-1179 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
3. 0j,Nizi, pz, „.1 0.4
MAILING AgKESSg t�
4. ADDRESS
CONTRAiT19P
LICENSE EXPIRES
DESIGNER
5. ADDRESS
CHANGE OF USE FROM
6.
PHONE
PHONE
ZIP
PHONE
ZIP
TO
TYPE .I1'NEW ❑ ALT. ❑ AD' N. ❑ RPL. ❑ MVE.
7. OF❑ OTHER
WORK ❑ BLD. ❑ PLMB.,B`MECH. ❑ M.H. ❑ POOL
PARCEL NO.
LEGAL DESCRIPTION:
Actual Set Backs in Feet to:
North !South [East West
Size of Parcel Zone Classification
Type Const.
Occupancy
Residential 0
Commercial ■
Sprinklered
❑Yes ENo ❑Req'd.
New Const. Valuation 1 Remodeled Valuation
Main Floor
Cover Deck
No. Baths
Certifi. of Exempt.
or Variance
Total Bldg. Floor Area
Upper Floors
Garage/Storage
Greenhouse
Uncv. Deck
Fin. Basemen
No. Floors
No. Fin, Rooms
Unf in. Basement
No. Dwellings
Required Yes❑ No El
Received Yes❑ No El
Number
DES¢RIBE WORK / VCi
GAS
VALUATION SOURCE
9•F
UTILLIITIES
(ELECTRIC
-e I kiIt\la-r
WATER SEWAGE
PUBLIC ❑ SEPTIC E
PRIVATE ❑ SEWER ❑
Shorelines/Flood Hazard Plans Required E
Yes NotApplic. ❑ Received E
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 I SPECTIONS
SIGNATURE OF ti, �s �7 APPLICATION _ �y
4j -w -K7 7'�. i!YL DATE /1-7—
OWNER OR AGENT
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. Horne
Other (Specify)
TOTAL $
30
PERMIT NUMBER
04* *3000
*30.006
A *000
1 1 7,82
11-01-83
6479.
CH a Pnov
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATEtS3UEJ 1 — 8
PERMITIJ(i /. 7 z
*3 0.0 0 �,L