1984, 04-20 Permit: 84A-3613 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. 3F08 P-_
PARCEL NO.
LOT BLOCK
2.
SUBDIVISION
3.
r1atvig.) L-PESMIn.+
MAILING ADDRESS
PHONE
Pq Zz —0334
LEGAL DESCRIPTION:
ZIP
Actual Set Backs In Feet to:
North (South 'East 1 West
4.
CONTRACTOR
ADDRESS
LICENSE EXPIRES
PHONE
ZIP
Size of Parcel
Type Const.
Occupancy
Zone Classification
Residential 0
Commercial 0
Spr nklered
DYes ONo DReq'd.
5.
DESIGNER
PHONE
New Const. Valuation
Remodeled Valuation
Total Bldg. Floor 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 pg -NEW 0 ALT. 0 AD' N. 0 RPL. 0 MVE.
7. OF ❑ OTHER
WORK 0 BLD. 0 PLMB.�MECH. 0 M.H. 0 POOL
No. Baths
No. Floors
No. Fin. Rooms
No Dwellings
Certif1. of Exempt.
or Variance
Required Vest NoO
Received YesD No
Number
8.
DESCRIBE WORK
VALUATION
9.
WooO 9roUE% wirop6owthi C44)AMpl
SOURCE
OF
UTILITIES
GAS
ELECTRIC
WATER
PUBLIC 0
PRIVATE 0
SEWAGE
SEPTIC 0
SEWER D
Shorelines/Flood Hazard
YesD Not Apolic.0
Flans Requ red 0
Received 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 FOR REOUI D INSPECTIONS
SIGNATURE OF ---ye
OWNER
-1 (-
OWNER OR AGENT
SPECIAL APPROVALS
PRELIM FINAL DATE
Env. Health
Planning
Fire
Prevent.
Englneer
Utilities
SEPA
Plans
Exam.
Building
Tech.
DATECATIO d ��
SPECIAL CONDITIONS: (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
Mech.
Plan Check
SEPA
Modular/
MFG. Home
00
Other (Specify)
TOTAL $
PERMIT NUMBER
OTA- '369/3
04* *3000
*30.00'6
A *000
361.2
04-20-84
2 6479,
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATEYSSt1E62 0 .4
PERMIT�tl. t. 3 * 3 O. 0 0 IOIrAL