1983, 12-20 Permit: 83B-2682 WoodstovePLAN NUMBER APPLICATION /PERMIT PERMITNUMBER
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
STREETADDRESSPARCEL NO.,
//�" /� �/�
11Z&
LOT
BLOCK
SUBDIVISION
LEGAL DESCRIPTION:
2.
I
OWNER
PHONE
PHONE
3. NIM PoI &
I
q2'� —B 7&
MAILING ADDRESS
ZIP
Actual Set Backs in Feet to:
1�,Q I Y -ANF R -
9"Cl _'� n(P
North South East West
CONTRACTOR
LIC NSE EXPIRES
PHONE
Size of Parcel
Zone Classif ication
Residential ❑
4.
1 1
Commercial ❑
ADDRESS
ZIP
Type Const.
Occupancy
Sprinklered
❑Yes ❑No ❑Req'd.
DESIGNER
PHONE
New Const. Valuation
Remodeled Valuation
Total Bldg. Floor Area
5.
ADDRESS
ZIP
Main Floor Upper
Floors
Garage/Storage
Greenhouse
R
CHANGE OF USE FROM
TO
Cover Deck
Uncv. Deck
Fin. Basement
Unf in. Basement
6.
No. Baths No.
Floors
No. Fin. Rooms
No. Dwellings
TYPE 'NEW El ALT. ❑ AD'N. El RPL. El MVE.
El OTHER
7. OF WORK El BLD. El PLMB.�IMECH. El M. H. El POOL
Certifi.ofExempt.
Required Yes❑ No❑
Number
or Variance
Received Yes❑ No❑
DESCRIBE WORK ��'' 11
8
60 V �✓
Shorelines/ Flood Hazard
Plans Required El
W0Q12
Yes Not Applic. ❑
Received ❑
VALUATION I
9•
SOOUFCE
GAS
ELECTRIC
PUB IWATC ❑
SEPT CG❑
Ownership
FEES COLLECTED
UTILITIES
PRIVATE ❑
SEWER ❑
Public ❑ Private ❑
1 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-
Building
thority to violate or cancel the provisions of any other state or local law regulating construction or the performance
of construction. SEE REVERSE IDE FO EOU RE SPECTIONS
Plumbing
SIGNATURE OF t, APPLICATION
o
� q�
OWNER OR AGENT DATE l20
Mach. •
SPECIAL
APPROVALS
SPECIAL CONDITIONS: (SEE ERSE SIDE FOR NOTICE)
PRELIM.
FINAL
DATE
Plan Check
Env. Health
SEPA
Planning
Modular/
MFG. Home
y
a
Fire
Prevent.
Other (Specify)
C
Engineer
��
LL
LL
Utilities
TOTAL $
SEPA
PERMIT IS NONTRANSFERABLE
WHEN MACHINE VALIDATED IN
THIS BECOMES A PERMIT.
THIS SPACE,
Plans
Exam.
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
j _ -
DATE UED� O i PERMIT"
8, 2 z * 0, 2 0 -,%T-JAL
Building
Tech.
J
i �/