1983, 01-18 Permit: 83A-0436 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
1.
STREET A DRESS
6P- IIOOI 41
LOT
2.
BLOCK
SUBDIVISION
3. OWN R f I G
MNG R S
- AD i 01 1441/4l fJ
con.Fy..J.
4.
c5
PHONE
PARCEL NO.
LEGAL UESCThTION:
//7 nc.c>
Actual Set Backs In Feet to'
North 'South (East I Wast
LICENSE EXPIRES
PHONE
Size of Parcel - I Zone Classification
Residential 0
Commercial 0
ADDRESS
ZIP
TYPO Carat.
Occupancy
Spr nklered
❑Yes ONo OReq'd.
5.
DESIGNER
PHONE
New Const. Valuation
Remodeled Valuation
Total Bldg. Floor Area
ADDRESS
ZIP
Main Floor
Upper Floors
Garage/Storage
Greenhouse
6.
CHANGE OF USE FROM
TO
Cover Deck
Uncv. Deck
Fin. Basement
Unfin Basement
TYPE {NEW
7. OF
WORK 0 BLD.
0 ALT. ❑��AD' N. ❑ RPL. 0 MVE.
❑ PLMB.Z1 ECH. ❑ M.H. 0 POOL
0 OTHER
No. Baths
No Floors
No. Fin. Rooms
No. Dwellings
Certiti. of Exempt.
or Variance
Required Yes❑ No0
Received VesO No0
Number
8. DESCk t7M
VALUATION
9:
SOURCE
OF
UTILITIES
GAS
Shorelines/Flood Hazard
YesO Not Appllc. 0
Plans Requ'red
Received 0
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 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 R DE FOR UIRED INSPECTIONS
SIGNATURE OF
OWNER OR AGENT APPLICATION OJ/8 3
l/ C� ✓
SPECIAL APPROVALS
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. Horne
Other (Specify)
TOTAL $
PERM' UM4?
C J (��
04* *2900
4352
01-18-83
2 6479.
G0
O
V
W
J
la -
WHEN
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
II��11UE8•k
DATEISS� —'.11
PERMIT N9.3 6 z * 2.0:0 0 QOdTAL