1983, 10-10 Permti: 83B-220 WoodstoveAPPLICATION/PERMIT
SPOKANE COUNTY - DEPARTMENT OF BUILDING & SAFETY
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
PERMIT NUMBER
V.
ADDRESSZIP
APPLICANT: COMPLETE NUMBERED SPACES —PRESS HARD TO MAKE 3 COPIES
Floors
STREET ADDRESS
Greenhouse
PARCEL NO.
�.
.
i1O
Fin. Basement
Unfin. Basement
s.
LOT
BLOCK
SUBDIVISION
LEGAL DESCRIPTION:
2.
No. Baths No.
Floors
No. Fin. Rooms
No. Dwellings
OWNER
PHONE
PHONE
3.
'A"L L->rtry c
I
MAILING ADDRESS
ZIP
Actual Set Backs in Feet to:
Required
X}, ( k 0 (
� ilar�l2o
WORK ❑ BLD. ❑ PLMB.e MECH. ❑ M.H. ❑ POOL
ero—
North South East West
or Variance
CONTRACTOR
Yes❑ No❑
LICENSE EXPIRES
PHONE
Size of Parcel
Zone Classification
Residential❑
4.
'SAY1r1 E
Received ❑
VALUATION I
9
SOURCE GAS
OF
I
I Commercial ❑
SEWAGE
SEPTIC ❑
ADDRESS
FEES COLLECTED
ZIP
Type Const.
Occupancy
Sprinklered
❑
M C-'
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
❑Yes ❑No ❑Req'd.
DESIGNER
Building
PHONE
New Const. Valuation
Remodeled Valuation
Total Bldg. Floor Area
Plumbing
/
SIGNATURE OF CATI
OWNER OR AGEN DATEQ
Mech.
PERMIT NUMBER
V.
ADDRESSZIP
Main Floor Upper
Floors
Garage/Storage
Greenhouse
CHANGE OF USE FROM
ver CoDeck
Uncv. Deck
Fin. Basement
Unfin. Basement
s.
TO——
No. Baths No.
Floors
No. Fin. Rooms
No. Dwellings
TOFPE El ALT. El AD'N. El RPL. El MVE.
NEW
7 ❑OTHER
Certifi.ofExempt.
Required
Yes❑ No❑
Number
WORK ❑ BLD. ❑ PLMB.e MECH. ❑ M.H. ❑ POOL
or Variance
Received
Yes❑ No❑
8 DESCRIBE WORK
Shorelines/ Flood Hazard
Plans Required ❑
Ll)ooi- t'(�
Yes❑ Not Applic. ❑
Received ❑
VALUATION I
9
SOURCE GAS
OF
ELECTRIC
WATER
PUBLIC ❑
SEWAGE
SEPTIC ❑
Ownership
FEES COLLECTED
UTILITIES
PRIVATE ElSEWER
❑
Public ❑ 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-
Building
thority to violate or cancel the provisions of any other state or local law regulating construction or the performance
of construction. SEE REV IDE FO QUIRED INSPECTIONS
Plumbing
/
SIGNATURE OF CATI
OWNER OR AGEN DATEQ
Mech.
SPECIAL APPROVALS
SPECIAL CONDITIONS (SEE REVERSE SIDE FOR NOTICE)
PRELIM.
FINAL
DATE
Plan Check
Env. Health
SEPA
Planning
Modular/
MFG. Home
>
G
Fire
Prevent.
Other (Specify)
C
C.
Engineer
U
V
Utilities
_
TOTAL $
SEPA
PERMIT IS NONTRANSFERABLE
WHEN MACHINE VALIDATED IN
THIS BECOMES A PERMIT.
THIS SPACE,
Plans
Exam.
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS—
^_ I _
DATE ISSUED l 0 a PFRMIT
o O J
2. U z 3 �'
Tech'^g
/�:
Nn2 TATeI