1983, 09-22 Permit: 83A-9387 WoodstovePLAN 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
LOT
(o I Z 5•. HER ALD i Ab
BLOCK
SUBDIVISION
PARCEL NO.
OWNER
S�;-�� G)�3soN
MAILING ADESS
S. iOIz 14gRALD POND
PHONE
�tNE 147,
PHONE
LEGAL DESCRIPTION:
ZIP
ggz06
Actual Set Backs in Feet to:
North (South (East 1 West
CONTRACTOR
LICENSE EXPIRES
PHONE
Size of Parcel 1 Zone Classification
Residential ❑
Commercial ❑
ADDRESS
ZIP
Type Const.
Occupancy
Spr nklered
❑Yes ❑No ❑Req'd.
DESIGNER
PHONE
New Const. Valuation
Remodeled Valuation
Total Bldg. Floor Area
ADDRESS
ZIP
Main Floor
Upper Floors
Garage/Storage
Greenhouse
CHANGE OF USE FROM
TO
Cover Deck
Uncv. Deck
Fin. Basement
Unfin. Basement
TYPEW ❑ ALT. 0 AD' N. 0 RPL. 0 MVE.
OF ❑ BLD. ❑ PLMB.H. 0 M.H. 0 POOL
WORK tt
DESCRIBE WORK
talon s fisirrfiLLP11014
VALUATION SOOURCE GAS
UTILITIES
ELECTRIC
0 OTHER
No. Baths
No. Floors
No. Fin. Rooms
No. Dwellings
Certif1. of Exempt.
or Variance
Required Yes❑ No❑
Received Yes Non
Number
Shorelines/Flood Hazard
Yes Not Applic. ❑
Plans Requ'red ❑
Received ❑
WATER
PUBLIC ❑
PRIVATE ❑
SEWAGE
SEPTIC ❑
SEWER ❑
Ownership
Public ❑ 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 the provisions of any other state or local law regulating construction or the performance
of construction. SEE REVERSE SIDE FOR REQUIRED INSPECTIONS
SIGNATURE OF
OWNER OR AGENT
SPECIAL APPROVAL$]
PRELIM. FINAL DATE
APPLICATION
r l• tom.\ DATE
\ SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
inv. Health
'Ianning
ire
'revent.
:ngineer
itilities
EPA
fans
:xam.
'Iuilding
ech.
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) %D k
0°J
TOTAL $
PERMIT NUMBER
'3A– cf3e7
0i)
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATEYSSUEL2 2 - 8 3
PERMIT'N�. � 7 2 * 3 R 0 0 gt*AL