1983, 07-06 Permit: 83A-6211 Wood StovePLAN NUMBER
1.
STREETDDRESS
r.
BLOCR SUBDIVISION
LOT
2.
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
MA141NG ADDRESS CP 5'LL'IN
PHONE
4.
CONTRACTQR�
LICENSE EXPIRES
ADDRESS
DESIGNER
ADDRESS
CHANGE OF USE FROM
HON
ZIP
E
PHONE
ZIP
PHONE
ZIP
TO
TYPE .01NEW ❑ ALT. ❑ AD' N. ❑ RPL. ❑ MVE.
7. OF WORK ❑ BLD. ❑ PLMB. ?MECH. ElM.H. ElPOOL ❑OTHER
PARCEL NO.
LEGAL DESCRIPTION:
Actual Set Backs in Feet to:
North South {East I West
Size of Parcel
Zone Classification
Type Const.
Occupancy
Residential ❑
Commercial ❑
Sprinklered
❑Yes ❑No ❑Req'd.
New Const. Valuation
Remodeled Valuation
Total Bldg. Floor Area
Main Floor
Upper Floors
Garage/Storage
Greenhouse
Cover Deck
Uncv. Deck
Fin. Basement
Unfin. Basement
No. Baths
No. Floors
No. Fin. Rooms
No. Dwellings
Certifi. of Exempt.
or Variance
Required Yes❑ No❑
Received YesE NoD
Number
DESCRI E WORK
8. 6-'40 O��j
VALUATION
9.
SOURCE
UTILITIES
GAS
ELECTRIC
WATER SEWAGE
PUBLIC D SEPTIC ❑
PRIVATE 9 SEWER 0
Shorelines/Flood Hazard
Yes❑ Not Applic. ❑
Ownership
Public ❑ Private ❑
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 performanr.
of construction. SEE REVERSE SIDE FOR REQUIRED INSPECTIONS
SIGNATURE OF % APPLICATION /�
OWNER OR AGENT N6��3'1/(/LfJ DATE
SPECIAL APPROVALS
PRELIM. FINAL DATE
Env. Health
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
SPECIAL CONDITIQNS: (SEE REVERSE SIDE FOR NOTICE)
PERMIT IS NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
Plans Required D
Received ❑
FEES COLLECTED
Building
Plumbing
Mech.
Plan Check
SEPA
Modular/
MFG. Home
Other (Specify)
TOTAL $
0
PERMIT NUMBER
04* *20,00
621,02
07-25-83
6479.
V 4:N MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
07;06-83
DATE ISSUED
PERMIT 211. 1z *20,00
O
DTAL