1984, 01-16 Permit: 84A-432 Wood StovePLAN NUMBER
APPLICATION/PERMIT
SPOKANE COUNTY - DEPARTMENT OF BUILDING & SAFETY
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99280 / (509) 456-3875
APPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 3 COPIES
PARCEL NO.
STREET ADDRESS
1. � - 12 2'-4— c I.
LOT
2.
BLOCK
SUBDIVISION
OWNER
3. la \110
MAILING ADDRESS
PHONE
PHONE
LEGAL DESCRIPTION:
• I2q c1L}11tF1t;
CONTRACTOR
4-
GOAD DRESS
Actual Set Backs in Feet to•
North 'South East I West
LICENSE EXPIRES
PHONE
Size of Parcel
Zone Classification
Residential 0
Commercial 0
ZIP
Type Const.
Occupancy
Spr nklered
0Yes ONo El Reg 'd.
5.
DESIGNER
PHONE
New Const. Valuation
Remodeled Valuation
Total Bldg Floer Area
ADDRESS
ZIP
Main Floor
Upper Floors
Garage/Storage
Greenhouse
CHANGE OF USE FROM
6.
TO
Cover Deck
Uncv. Deck
Fin. Basement
Unfin Basement
TYPE .er NEW ❑ ALT. 0 AD' N. 0 RPL. ❑ MVE.
7. OF
WORK 0 BLD. 0 PLMB. l MECH. 0 M.H. 0 POOL
0 OTHER
NO. Baths
No. Floors
No. Fin. Rooms
No. Dwellings
Certlfi. of Exempt.
or Variance
Required Yes0 No0
Received Yes° No0
Number
8.
DESCRIBEWORK
IA1e 1-0\/C
Shorelines/Flood Hazard
Yes° Not Applic.0
Plans Req !red 0
Received 0
VALUATION
9.
SOURCE
F
lfrILLIITIES
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:4 e provisionof . ny other state or local law regulating construction or the performance
of construction. SEE REV
3; SE SIDE FALMOUIRED INSPECTIONS
i.
SIGNATURE OF
OWNER OR AGENT
APPLICATION
DATE
SPECIAL APPROVALS SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PRELIM. FINAL DATE
Env. Health
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.. .
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)
So -
TOTAL $
PERMIT NUMBER
MA -43i
04* *20.00
*2Q008
A *0.00
43.12
0,1-16-84
2 6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
1 11. v r tt 1 '
DATEi((IIsliUEd 6 8 4
PERMIT Ng. 32 Z
*20,OO(FETAL