1983, 12-27 Permit: 83B-2788 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" ..fir.K/1/ 7-0A/ ie -D.
LOT BLOCK SUBDIVISION
2.
PARCEL NO.
LEGAL DESCRIPTION:
�O y/NER , /
3t"/,,10,L Z W/ /T—
MAILING ADDRESS NGc
PHONE
f.? -/707
PHONE
ZIP
Actual Set Backs in Feet to:
North j South East I West
4.
5.
6.
OliTRACTOR
ADDRESS—U/61/4? 6/P .. j,4'eMPA/ fj;P�
A/ >3.1 ]i/_Si O A/
LICENSE EXPIRES PHONE
7TSf49W/P-. i
ZIP
;9,-A7
Size of Parcel 1 Zone Classification
Residential ❑
Commercial ❑
Type Const.
Occupancy
Sprinklered
❑Yes 0 N ❑Req'd.
DESIGNER
/VA •
ADDRESS
PHONE
New Const. Valuation
Remode ed Valuation
Total Bldg. Floor Area
ZIP
Main Floor
Upper Floors
Garage/Storage
Greenhouse
CHANGE OF USE FROM
TO
Cover Deck
Uncv. Deck
Fin. Basement
Unfin. Basement
TYPE 0 NEW 0 ALT. ❑ AD' N. 0 RPL. ❑ MVE.
7. OF
WORK ❑ BLD. 0 PLMB. 0 MECH. 0 M.H. 0 POOL
0 OTHER
No. Baths
No. Floors
No. Fin. Rooms
No. Dwellings
Certifi. of Exempt.
or Variance
Required Yes❑ No❑
Received Yes No❑
Number
DESCRIBE WORK
8. T7/(457 -A7/1/4 in t/ - z, -,)e)/1,5 -TD vi,_ . 6/i �, 477--
VALUATION SOURCE
9
UTILITIES
GAS
ELECTRIC
Shorelines/Flood Hazard
Yes❑ Not Applic. ❑
Plans Required ❑
Received ❑
ATER SEWAGE
PUBLIC ❑ SEPTIC ❑
PRIVATE ❑ SEWER ❑
Ownership
Public ❑ Private ❑
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 REVERSE SIDE FOR REG) IRED INSPECTIONS
SIGNATURE OF
OWNER ORACliPP
APPLICATION
DATE
4�.
SPECIAL APPROVAL D SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PRELIM. FINAL DATE
Env. Health
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
/07
PERMIT IS NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
FEES COLLECTED
Building
Plumbing
VO
Mech. �
Plan Check
SEPA
Modular/
MFG. Home
Other (Specify)
ev
TOTAL $
PERMIT NUMBER
g 5 — 2780
04* *20.00
*20,006
A *0.00
278.72
,12-27-83
z 6,479,
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
jj
.44. �qod„z
DATE1IS�UE0- 7' - 8' 3
PERMIT2N .8. 8 2
* 2 0.0 0IAL