1983, 09-02 Permit: 83A-8529 WoodstovePLAN 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
1.
2.
ST EET ADDRESS
2LOT. 2-o 12.-
LOT
BLOCK
PARCEL NO.
SUBDIVISIO
3.
OWDor`1 X11
MNitING ADDRESS
PHONE
CONT
ci
4. ADDRESS
LICENSE EXPIRES
PHONE
LEGAL DESCRIPTION:
Actual Set Backs in Feet to:
North (South [East ( West
Size of Parcel
Zone Classification
Residential 0
Commercial 0
ZIP
Type Const.
Occupancy
Spr nklered
❑Yes ❑No ❑Req'd.
DESIGNER
FJ. ADDRESS
PHONE
New Const. Valuation
Remode ed Valuation
Total Bldg. Floor Area
ZIP
Main Floor
Upper Floors
Garage/Storage
Greenhouse
CHANGE OF USE FROM
6.
TO
Cover Deck
Uncv. Deck
Fin. Basement
Unfin. Basement
TYPE Ia'NEW ❑ ALT. ❑ N. ❑ RPL. ❑ MVE.
7. OF
0 BLD. 0 PLMB.4 MECH. 0 M.H. 0 POOL
WORK
0 OTHER
No. Baths
No. Floors
No. Fin. Rooms
No. Dwellings
Certifi. of Exempt.
or Variance
Required Yes❑ No❑
Received Yes No❑
Number
8. DEstc/ RK-ro6
Shorelines/Flood Hazard
Yes❑ Not Applic. 0
Plans Required 0
Received 0
VALUATION
9.
SOURCE
UTILLIITIES
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 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 p ovisions of any other state or local law regulating construction or the performance
of construction. SEE REVERS IDE FOR UI ED INSPECTIONS II
is.> SIGNATURE OF -APPLICATION ,
OWNER OR AGENT
SPECIAL APPROVALS SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PRELIM. FINAL DATE
Env. Health
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
2')
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
Other (Specify)
TOTAL $ -
PERMIT4jNUMQB�ER
04* *2000
*20,00
A *000 8
85282
D9-02-83
2 6 11. 7 9.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
09 02-+8:'3'
DATE ISSUED
PERMIT N05 2= 'z * 2:0.'0 04TA,L