1984, 02-06 Permit: 84A-1033 Wood Stove PLAN NUMBER APPLICATION/PERMIT ' PERMIT NUMBER
SPOKANE COUNTY — DEPARTMENT OF BUILDING &SAFETY ei'P - Id==�'
NORTH 811 JEFFERSON/SPOKANE,WASHINGTON 99260/(509)456-3675
APPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 3 COPIES
STREET ADDRESS ,
PARCEL NO.
1. -� --P.A,.(th.bC- n Cb tZ-
LOT BLOCK SUBDIVISION LEGAL DESCRIPTION:
2.
OWNER PHONE PHONE
_..) riZ . �'.Lei.5 Gt ? <-27›
3 MAILING ADDRESS ZIP Actual Set Backs in Feet to:
'Ito E. l\b V-3 . --D...''.3 �CCZ_ G North 'South Eaat I west
CONTRACTOR LICENSE EXPIRES PHONE Size of Parcel ZoneClassification Residential
c_.. ti
" Ylc Commercial 0
4. ADDRESS ZIP Type Const. Occupancy Sprinklered
c i Yt t. ❑Yes 0 N ❑Req'd.
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 Unf in.Basement
6.
No.Baths No.Floors No.Fin.Rooms No.Dwellings
7
TYPE �W 0 ALT. ❑ D'N. 0 RPL. 0 MVE.OF ❑ OTHER
WORK
0 BLD. 0 PLMB. MECH. ❑ M.H. 0 POOL Certifi.of Exempt. Required Yes❑ No❑ Number
or Variance Received Yes 0 No❑
DESCRIBE WORK Shorelines/Flood Hazard Plans Required❑
8• wzr*D -as=otii Yes Not Applic.0 Received ❑
VALUATION SOURCE GAS ELECTRIC WATER SEWAGE Ownership FEES COLLECTED
9. OF
UTILITIES PUBLIC❑
PRIVATE❑ SEPTIC❑
SEWER❑ Public 0 Private 0
1 _i
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 Building
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 Plumbing
SIGNATURE OF % / APPLICATI e N
OWNER OR AGENT I' `" DATE - 0 y Mech. 20-Ce-
SPECIAL APPRO4ALS SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PRELIM. F�ly( AL DATE Plan Check
Env.Health IJ
SEPA
Planning
Modular/
Fire MFG.Home
Prevent. a
O
Engineer Other(Specify) LU
Utilities
II
TOTAL $ -'2-C"`
SEPA
PERMIT IS NONTRANSFERABLE WHEN MACHINE VALIDATED IN THIS SPACE,
Plans THIS BECOMES A PERMIT.
Exam.
n' PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
BuildingIA/
IN 180 DAYS I) ;�
L - /I, l` y ) o o
Tech.
9e-- -
DATE IS UEIP U PERMIT N�'1.)' 2 * 2 U. 0 9'OkfAL