1983, 12-12 Permit: 83B-2450 Wood StovePLAN NUMBER
1
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
E. -13z..%
LOT
2.
BLOCK
OWNER
3.ToCDD
SUBDIVISION
`FD€2�,EN
MAILING ADDRESS
CONTRACTOR
4.
5.
vZY
ADDRESS
DESIGNER
PHONE
LICENSE EXPIRES
PHONE
rte— 4c
ADDRESS
CHANGE OF USE FROM
PHONE
ZIP
PHONE
ZIP
TO
TYPE /NEW ❑ ALT. ❑ ' N. ❑ RPL. ❑ MVE.
7. OF
WORK ❑ BLD. ❑ PLMB. C�MECH ❑ M.H. ❑ POOL ❑OTHER
DESCRIBE WORK
8. tJ..:C cx� rip 0E7
VALUATION SOURCE GAS ELECTRIC WATER SEWAGE
9 OF PUBLIC 0 SEPTIC 0
UTILITIES PRIVATE ❑ SEWER ❑
PARCEL NO.
LEGAL DESCRIPTION:
Actual Set Backs in Feet to:
North (South IEast `West
Size of Parcel
Type Const.
Occupancy
New Const. Valuation
Main Floor
Zone Classification
Residential ❑
Commercial ❑
Spr'nklered
EYes ❑No Req 'd.
Remodeled Valuation
Upper Floors
Cover Deck
No. Baths
Total Bldg. Floor Area
Garage/Storage
Uncv. Deck
No. Floors
Certifi. of Exempt.
or Variance
Greenhouse
Fin. Basement
No. Fin. Rooms
Required Yes No
Received Yes No
-
Shorelines/Flood Hazard
Yes ID Not Applic. ❑
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
APPLICATION
DATE %a'
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
Unfin. Basement
No. Dwellings
Number
Plans Required ❑
Received ❑
FEES COLLECTED
Building
Plumbing
Mech. 0o •
Plan Check
SEPA
Modular/
MFG. Home
Other (Specify)
TOTAL $ 9'0' re
PERMIT NUMBER
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATE ED` 2 -8 5
245.05 *20,00
PERMIT NO.
O J
al -
TOTAL