1983, 12-09 Permit: 83B-2412 Wood Stove�rLMr'A M6GrS I ArrL1%o#% I IVIN/ I r_r1M1 1 VtHIVlll NUMt3tH
SPOKANE COUNTY — DEPARTMENT OF BUILDING & SAFETY'? IZ>
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
STREET ADDRESS 1PARCELNO.
1. � I ZS 2 z t.5N GRi�
2.
LOTF6—L6"UBDIVISION
OWNER
3. k (hal MAILING ADDRESS
ADDRESS
�ff_i�
CONTRACTOR
4.
ADDRESS
DESIGNER
5.
ADDRESS
iONE PHONE
Z& —773-7 1 2,5c�_—
ZIP
LICENSE EXPIRES PHONE
ZIP
PHONE
ZIP
Actual bet uwKs In Feet to:
North South East West
Size of Parcel Zone Classification Residential ❑
Commercial ❑
Type Const. Occupancy Sprinklered
❑Yes ❑No ❑Req'd.
New Const. Valuation Remodeled Valuation I Total Bldg. Floor Area
Main Floor I Upper Floors I Garage/ Storage I Greenhouse
CHANGE OF USE FROM I TO I Cover Deck Uncv. Deck Fin. Basement Unfin. Basement
6.
/
TYPE ,_,NEW El El
No. Baths
No. Floors
No. Fin. Rooms
No. Dwellings
1!J ALT. El AD'N. RPL.
7. OF
WORK ❑ BLD. ❑ PLMB.,ZMECH. ❑ M.H.
El MVE.
❑ OTHER
❑ POOL
Certifi. of Exempt.
Required
Yes❑ No❑
Number
or Variance
1
Received
Yes EJ No❑
8 DESCRIBE WORK
Shorelines/ Flood Hazard
Plans Required ❑
C01? 51�
Yes❑ Not Applic. ❑
Received ❑
VALUATION
SOURCE
OF
GAS
ELECTRIC
I
WATER
PUBLIC ❑
I SEWAGE
SEPTIC ❑
Ownership
1
FEES COLLECTED
U. UTILITIES PRIVATE ❑ SEWER ❑ 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-
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 1 APPLICATION
OWNER OR AGENT DATE��
SPECIAL APPROVALS -" SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PRELIM. FINAL DATE
Env. Health
Planning
Utilities
Plans I I I I PERMIT IS NONTRANSFERABLE
Exam. PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
Building IN 180 DAYS
Tech.
Building
Plumbing
Mean. 2 °�
Plan Check
SEPA
Modular/
MFG. Home
Other (Specify)
TOTAL $
WHEN MACHINE VALIDATED IN TH
THIS BECOMES A PERMIT.
DATEIS41JI Y_ PERM11". J.. 2 z * 2 0. 0 0 R4JTAL
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