1983, 08-10 Permit: 83A-7559 Woodstove#-%F-F-L_1Lh 1 IVItl/ VC rjMI 1
SPOKANE COUNTY - DEPARTMENT OF BUILDING & SAFETY
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
v AtJPLIUANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 3 COPIES
STREET ADDRESS
S . ?_ -0 � PARCEL NO.
2. LOT BLOCK SUBDIVISION LEGAL DESCRIPTION:
OWNER
PHONE
PHONE
3.-itpNl: �.v ► l L.l YZw� `�
MAILING ADDRESS
ZIP
Actual Set Backs in Feet to:
S • -_Lso6 �LI'✓N6�J
4+���
North South East West
CONTRACTOR
CG 114 r�tE
LICENSE EXPIRES
PHONE
Size of Parcel
Zone Classification
4•
Residential ❑
Commercial ❑
ADDRESS
c-!
ZIP
Type Const.
Occupancy
Sprinklered
❑Yes ❑No ❑Req'd.
DESIGNER
PHONE
New Const. Valuation Remodeled Valuation Total Bldg. Floor Area
5.
Main Floor Upper Floors Garage/Storage Greenhouse
Cover Deck Uncv. Deck Fin. Basement Unfin. Basement
No. Baths No. Floors No. Fin. Rooms No. Dwellings
ADDRESS
ZIP
s. CHANGE OF USE FROM
TO
TYPE NEW ❑ALT. ❑ AD'N. El RPL. ❑ MVE.
7•
OF ❑BLD. ❑ PLMB. / ❑ OTHER
WORK C"MECH. ❑ M.H. ❑ POOL
Certifi. of Exempt. Required Yes No❑ Number
or Variance Received Yes❑ No❑
DESCRIBEWORK
8' Wt">D S-'CovE�
Shorelines/Flood Hazard Plans Required
Yes Not Applic. ❑ Received ❑
VALUATION
9'
I SOOURCE
GAS
ELECTRIC
WATER
SEWAGE
Ownership
UTILITIES
PRIVATE ❑
SEWER O
Public ❑ Private ❑
FEES COLLECTED
1 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 REVERSE SIDE FOR REQUIRED INSPECTIONS
Plumbing
SIGNATURE OF ) APPLICATI N
OWNER OR AGENT — DATE— /() —_
�=/�/hA��
Mach
SPECIAL APPR
PRELIM. FI
Env. Health
Planning
Prevent.
Utilities
Plans
Exam
SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PERMIT IS NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
sit D IN 180 DAYS
Plan Check
SEPA
Modular/
MFG.Home
Other (Specify)
TOTAL $
PERMIT NUMBER
47
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES APERMIT. 7
DATEY4Ui' 1(O 8 PERMIT/NO. z * Q. O O TOTAL
CL
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W
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