1984, 01-04 Permit: 84A-071 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
MfgINI.
PARCEL NO.
LOT
2.
BLOCK
SUBDIVISION
LEGAL DESCRIPTION:
OWNER
3 141 b0111—St
MAILING A IZ.SS r I d
PHON
'? -6,2-
PHONE
7
CONTRACT e
4. ADDRESS
LICENSE EXPIRES
Z
H 2E��
Actual Set Backs in Feet to:
North ISouth East I West
Size of Parcel Zone Classification
Residential 0
Commercial 0
ZIP
Type Const.
Occupancy
Sp nkiered
OYes DNo DReq.d
5.
DESIGNER
PHONE
New Const. Valuation
Remodeled Valuation
Total Bldg. Floor Area
ADDRESS
ZIP
Main Flax
Upper Floors
Garage/Storage
Greenhouse
6.
CHANGE OF USE FROM
TO
Cover Deck
Uncv Deck
Fin. Basement
Unfin Basement
TYPEr�NEW 0 ALT. 0 AD' N. 0 RPL.
WORK 0 BLD.. 0 PLMB. 12 /ECH. ° M.H
❑ MVE.
0 POOL
0 OTHER
No. Baths
No. Floors
No. Fin Rooms
No. Dwellings
CerlIti. of Exempt.
or Variance
Required Yes❑ No0
Received Yes° No0
Number
8.
9.
DESCRIB WORK
A000
VALUATION
S1° VC!
Shorelines/Flood Hazard
Yes° Not Applic. 0
Plans Required 0
Received 0
SOURCE
OF
UTILITIES
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 the provisions of any other state or local law regulating construction or the performance
of construction. SEE REVERSE SIDE FOR REOUIRED INSPECTIONS
SIGNATURE OF- APPLICATION / /"f'/ �//X�
OWNER OR AGENT.-- n (7 P 00— ) DATE l
SPECIAL APPROVALS SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PRELIM. FINAL DATE
Env. Health
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
V4 -
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)
TOTAL $
CSE/
PERMIT NUMBER
pj4-A - 07 I
04* *2Q00
*20.006
A *Q00 8
7.02
01-04-84
2 6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES1�A PERMIT.
EDD
DATE I L-04-8'4
PERMIT NO. 7.1 z
*2O.00.Po4L