1983, 12-12 Permit: 83B-2452 Wood StovePLAN NUMBER
APPLICATION/PERMIT
SPOKANE COUNTY — DEPARTM=NT 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
PARCEL NO.
BLOCK
SUBDIVISION
OWNER
3. 5 Or�T a 2Gv
MAILING ADDRESS
.Ut,7v..c+..Naiv
PHONE
PHONE
LEGAL DESCRIPTION:
ZIP
Actual Set Backs in Feet to:
North 1South East I West
4.
5.
CONTRACTOR
ADDRESS
vvIC
DESIGNER
LICENSE EXPIRES
PHONE
Size of Parcel 1 Zone Classification
Residential ❑
Commercial ❑
ZIP
Type Const.
Occupancy
Spr nklered
❑Yes ❑No ❑Req'd.
PHONE
New Const. Valuation
Remode ed Valuation
Total Bldg. Floor Area
ADDRESS
ZIP
Main Floor
Upper Floors
Garage/Storage
Greenhouse
CHANGE OF USE FROM
6.
TO
Cover Deck
Uncv. Deck
Fin. Basement
Unfin. Basement
TYPE O NEW ❑ ALT. ❑ AD' N. ❑ RPL. ❑ MVE.
7. OF ❑OTHER
WORK ❑ BLD. 111PLMB. ❑ MECH. ❑ M.H. ❑ POOL
No. Baths
No. Floors
No. Fin. Rooms
No. Dwellings
Certifi. of Exempt.
or Variance
Required Yes❑ No❑
Received Yes No [7
Number
DESCRIBE WORK
8. ' A_'Ct)c) s. rc L?
Shorelines/Flood Hazard
Yes NotApplic. ❑
Plans Required El
Received ❑
VALUATION
9.
SOURCE
UTILITIES
GAS
ELECTRIC
WATER
PUBLIC El
PRIVATE El
SEWAGE
SEPTIC ❑
SEWER ❑
Ownership
Public El 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 • SIDE FOR REQUIRED INSPECTIONS
SIGNATURE OF APPLIC
OWNER OR AGEN � a �. �1' _ DATE
SPECIAL APPROVA S SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PRELIM. FINAL DATE
Env. Health
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
/Z
PERMIT IS NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
FEES COLLECTED
Building
Plumbing
Mech. 2-40
Plan Check
SEPA
Modular/
MFG. Home
Other (Specify)
TOTAL $ cid
PERMIT NUMBER
63%315 —2-457—
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
12-12-6
DATE ISSUED
24522 *20.002
PERMIT NO. TOTAL