1983, 08-04 Permit: 83A-7385 Wood 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.
tJ . t (o 1'5 FEc T
PARCEL NO.
LOT
2.
BLOCK
SUBDIVISION
OWNER
3. MucC 4c1JSEN
MAILING ADDRESS
N . L(vt3 Fat"i
CONTRACTOR
eArvIC
ADDRESS
5AV4C
DESIGNER
4.
5.
PHONE
PHONE
LEGAL DESCRIPTION:
ZIP
c c -2.0C
Actual Set Backs In Feet toy
North 'South [East I West
LICENSE EXPIRES
PHONE
Size of Parcel 1 Zone Classification
Residential 0
Commercial 0
ZIP
Type Const.
Occupancy
Spr'nklered
OVes ONo DReq'd.
PHONE
New Const. Valuation
Remodeled Valuation
Total Bldg. Floor Area
ADDRESS
ZIP
Main Floor
Upper Floors
Garage/Storage
Greenhouse
6.
CHANGE OF USESEFROM
TYPE �t4EW
7. OF
WORK 0 BLD.
TO
Cover Deck
Uncv. Deck
Fin. Basement
UnIIn. Basement
0 ALT. DAD' N. D RPL. 0 MVE.
0 PLMB. ❑ MECH. 0 M.H. 0 POOL
0 OTHER
No. Baths
No. Floors
No. Fin. Rooms
No. Dwellings
Certdi. of Exempt.
or Variance
Required Yes0 No0
Received Yes No❑
Number
8.
9.
DESCRIBE WORK
wino
VALUATION
Shorelines/Flood Hazard
VesD Not Apollo. 0
Plans Requ red 0
Received 0
SOURCE GAS
F
UTILITIES
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 REVERSE SIDE F REOUIF}ED INSPECTIONS
SIGNATURE OF
OWNER OR AGENT _
%LW
APPLICATIQ{J g— q—
DATE I� 0 �7
SPECIAL APPROVALS SPECIAL CO
PRELIM. FINAL DATE
Env. Health
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
97
y
TIONS: (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
Mach
Plan Check
SEPA
Modular/
MFG. Home
Other (Specify)
TOTAL $
ro.co
PERMIT NUMBER
OSA — 7 6
04* *2000 -
*20.006
A *000 8
7384
08-04-83
2 6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
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