1983, 10-05 Permit: 83A-9939 WoodstovePLAN NUMBER
r,
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
1.e.
STREET ADDRESS
I LONC Ea -04)
PARCEL NO.
LOT
2.
BLOCK
SUBDIVISION
3.
OWNER
LeNt1 (<g--TrLesori
PHONE
7662.—
PHONE
66Z
PHONE
LEGAL DESCRIPTION:
MAILING ADDRESS
E I4-q-oI LoNGF%Llab1
ZIP
CONTRACTOR
4. simo
ADDRESS
LICENSE EXPIRES
PHONE
Actual Set Backs in Feet to:
North I South [East I West
Size of Parcel 1 Zone Classification
Residential ❑
Commercial ❑
ZIP
Type Const.
Occupancy
Sprinklered
❑Yes ❑No ❑Req'd.
DESIGNER
5.
ADDRESS
PHONE
New Const. Valuation
Remodeled Valuation
Total Bldg. Floor Area
ZIP
Main Floor
Upper Floors
Garage/Storage
Greenhouse
6.
CHANGE OF USE FROM
TO
Cover Deck
Uncv. Deck
Fin. Basement
Unfin. Basement
TYPE eNEW ❑ ALT. ❑ AD' N. ❑ RPL. ❑ MVE.
7. OF ❑ BLD. 0 PLMB. ECH. ❑ M.H. ❑ POOL
WORK
0 OTHER
No. Baths
No. Floors
No. Fin. Rooms
No. Dwellings
Certifi. of Exempt.
or Variance
Required Yes❑ No❑
Received Yes❑ No❑
Number
8.DESCRIBE WORK
wcop 5 iosiE 164S7A1-ijTiot4 ttrt F1so t4Ry cl+►mNE
VALUATION
9.
SOURCE
F
UTILLIITIES
GAS
T lel
ELECTRIC PUBLIC O
PRIVATE 9
Shorelines/Flood Hazard
Yes❑ Not Applic. ❑
Plans Required ❑
Received 0
SEWAGE
SEPTIC ❑
SEWER ❑
Ownership
Public 0 Private 0
I hereby certify that 1 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 REVER
SIGNATURE OF
OWNER OR AG
SPECIAL APROVALS
UIRED INSPECTIONS
APPLICATION
DATE
PRELIM. FINAL DATE
Env. Health
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
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
Q_
p0
Other (Specify) tO
oo
TOTAL $ .30
PERMIT NUMBER
e 3A- ??3 ?
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATE4S3UEDO S 3
PERMIT+,R . / / 0
*30,00 AL