1983, 09-28 Permit: 83A-9648 WoodstovePLAN NUMBER APPLICATIONJ PERMIT
SPOKANE COUNTY - DEPARTMENT OF BUILDING & SAFETY
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
1,_./ APPLICANT: COMPLETE NUMBERED SPACES -PRESS HARD TO MAKE 3 COPIES
STREETADDRESS PARCEL NO.
�. n .
LOT I BLOCK SUBDIVISION LEGAL DESCRIPTION:
2.
OWNERS �
O►y� �
yy -
PHONE
3.
MAILING ADDBASS�i
7 (� l� �� '
Actual Set Backs in Feet to:
-
North South East
West
CONTRACT R
LICENSE EXPIRES
PHONE
Size of Parcel
Zone Classification
Residential❑
4.
Commercial ❑
ADDRESS
ZIP
Type Const. Occupancy
Sprinklered
❑Yes ❑No E3 Req Id.
DESIGNER
PHONE
New Const. Valuation
Remodeled Valuation
Total Bldg. Floor Area
5.
ADDRESS
ZIP
Main Floor Upper
Floors
Garage/Storage
Greenhouse
CHANGE OF USE FROM
TO
Cover Deck
Uncv. Deck
Fin. Basement
Unfin. Basement
6.
TYPE
No. Baths No.
Floors
No. Fin. Rooms
No. Dwellings
7. OF Ja'NEW ❑ALT. ❑ AWN. ❑RPL. ❑ MVE. ❑OTHER
WORK ❑BLD. ❑ PLMB.�MECH. ❑ M.H. 11 POOL
Certifi.ofExempt.
Required
Yes❑ No❑
Number
or Variance
Received
Yes ❑ No ❑
DESCF;' WOR
8' w v
Shorelines/ Flood Hazard
Plans Required El
Yea❑ Not Applic. ❑
Received ❑
VALUATION I
9
SOOUFCE
GAS
ELECTRIC
PUBLIWATER
SEPTIC G❑
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 SIDE FOR REQUIRED INSPECTIONS
Plumbing
SIGNATURE OF APPLICATION
`2
2o -
OWNER OR AGENT DATE G 141'
Mach.
SPECIAL APPROVALS
PRELIM. FINAL DATE
Env. Health
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech. ' u 7 8
NDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PERMIT IS NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
Plan Check
SEPA
Modular/
MFG. Home
PERMIT NU!M:B7ER
i3 5k
Other (Specify)
TOTAL $
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
11 (J� 04��jj
DATEYSSUE� 0 P. / PERMANa_ 4A " z
*20.000-j
U