1984, 02-10 Permit: 84A-1144 Wood StoveUnfin. Basement
PLAN NUMBER
STREET ADDRESS
l v
41,./ 2
1.
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
BLOCK f SUBDIVISION
PARCEL NO.
oerit! l-
3.
MAILING ADDR
CONTRACTOR
4.
ADDRESS
pao
vv P,
s
PHONE
LICENSE EXPIRES
DESIGNER
5.
ADDRESS
6.
CHANGE OF USE FROM ! TO
PHON
D
ZIP
PHONE
ZIP
PHONE
ZIP
LEGAL DESCRIPTION:
Actual Set Backs in Feet to:
North South
Size of Parcel
East
West
Zone Classification
Residential ❑
Commercial ❑
Type Const. !Occupancy Spr nklered
❑Yes ❑No ❑ Req 'd.
New Const. Valuation
Main Floor
Cover Deck
Remodeled Valuation
!Upper Floors Garage/Storage
Uncv. Deck
TYPEEW E ALT. E AD' N. ❑ RPL. ❑ MVE.
7• OF ❑ OTHER
WORK ❑ BLD. ❑ PLMB.)igl,MECH. ❑ M.H. ❑ POOL
8.
9.
DESCRIBE WORK
VALUATION
GAS
ELECTRIC
SEWAGE
SEPTIC D
SEWER ❑
No. Baths
Certifi. of Exempt.
or Variance
No. Floors
Total Bldg. Floor Area
Greenhouse
Fin. Basement
No. Fin. Rooms
Required Yes❑ No
Received Yes❑ No
Shorelines/Flood Hazard
Yes NotApplic. ❑
Ownership
Public C 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 §IDE FOR R UIRED INSPECTIONS
•a
SIGNATURE OF
OWNER OR AGENT
SPECIAL AP7ROVALS SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PRELIM. FINAL DATE
APPLICATION �j (5t,.('
DATE
Env. Healtt
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
PERMIT IS NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
No. Dwellings
Number
Plans Required D.
Received
FEES COLLECTED
Building
Plumbing
Mech.
Plan Check
SEPA
Modular/
MFG. Home
Other (Specify)
TOTAL $
PERMIT NUMBER
CNA — !141
04* *20.00
*20.00
A *0,00 3
1 1 4,3�
02-10-84
.= 6479
0
C-1
W
J_
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATEUSl�IJ�OI C — n PERMIT1NO.4 4 z
*20.00 OAL