1983, 11-21 Permit: 83B-1899 Wood StovePLAN NUMBER
APPLICATION/PERMIT
SPOKANE COUNTY - DEPARTMENT OF BUILDING & SAFETY
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 1 (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 3 COPIES
TREET ADDRESS
LOT 1 BLOCK
DIT- -ofr‘O
SUBDIVISION
PARCEL NO.
2.
LEGAL DESCRIPTION:
3.
OWryrArsuls Irl. I'INIL
M LING ADDDRREES(S
• [4-11 blob- trz,
oAO
PHONE
3_ szii
PHONE
4.
CON�NT CT
LICENSE EXPIRES
Z7ol1
PH NE
Actual Set Backs In Feet to:
North ISouth [East IWest
Size of Parcel 1 Zone Classification
Residential 0
Commercial 0
ADDRESS
ZIP
Type Const.
Occupancy
Spr nklered
°Yes ONo 0Reg 'd.
5.
DESIGNER
PHONE
New Const. Valuation
Remodeled 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 ,NEW D ALT. ❑,9D'N. ❑ RPL. 0 MVE.
7. OF 0 BLD. 0 PLMB,XJ MECH. 0 M.H. 0 POOL
WORK
D OTHER
No. Baths
No. Floors
No. Fin. Rooms
No. Dwellings
Certlf1. of Exempt.
or Variance
Required Yes° No❑
Received Ves0 No0
Number
8. DESCvE 000K
Shorellnes/Flood Hazard
Yes° Not Apollc.0
Rare Requ red 0
Received 0
VALUATION
9.
SOURCE
OF
UTILITIES
GAS
ELECTRIC
WATER
PUBLIC 0
PRIVATE 0
SEWAGE
SEPTIC 0
SEWER 0
Ownership
Public 0 Private 0
I hereby certify that I have read and examined this appl cation 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 R VERSE SJD FOR REQUIRED INSPECTIONS
SIGNATURE OF
OWNER OR AGENT
SPECIAL APPROVALS
PRELIM. FINAL DATE
Env. Health
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
APPLICATION 2// 1/43
DATE
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. Home
r0_
Other (Specify)
TOTAL $
PERMIT NUMBER
04* *2Q00
*20.00
A *000 0
189.82
11-21-83
2 6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
1 N.:..;, . 8A
DATE ISW 1 D 1
'2 3
PERMIT NIL 9. 9 Z * 2 0.