1983, 10-03 Permit: 83A-9840 Wood Stove PLAN NUMBER APPLICATION/PERMIT PERMIT NUMBER
SPOKANE COUNTY - DEPARTMENT OF BUILDING & SAFETY � fA
NORTH 811 JEFFERSON/SPOKANE,WASHINGTON 99260/(509)456-3675
1, APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
STREET ADDRESS
PARCEL NO.
1. C
Y , k x ,
—.- . •I S 6. 12_....,--r cb4
LOT BLOCK SUBDIVISION LEGAL DESCRIPTION: c 3
2.
OWNER PHONE PHONE i
3. M.c4.40, -...... 'D. Cc5crt re-ffl CRD--e'(• ,
MAILING ADDRESS ZIP Actual Set Backs in Feet to:
l'4.5.1 C`[-C>nl r-EJ(aA eleoma;7 _North 'South [East I West
CONTRACTOR LICENSE EXPIRES PHONE Size of Parcel Zone Classification Residential 0
4. Commercial 0
ADDRESS ZIP Type Const. Occupancy Sprinklered
.t.01, ❑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
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 TYPE2/NEW ❑ ALT. ❑ AD'N. ❑ RPL. ❑ MVE. ❑ OTHER
WORK ❑ BLD. ❑ PLMB. dMECH. ❑ M.H. ❑ POOL Certifi.of Exempt. Required Yes No❑ Number
or Variance Received Yes No❑
DESCRIBE WORK Shorelines/Flood Hazard Plans Required❑
8. oQ TC tic, Yes Not Applic.❑ Received ❑
VALUATION SOURCEDGAS ELECTRIC PUBLIC❑ SEPTIC❑ Ownership FEES COLLECTED
9. UTILITIES PRIVATE❑ SEWER 0 Public❑Private❑
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 Plumbiig
SIGNATURE OF / APPLICATI1N
1.1OWNER OR AGEN . J . r, A. � DATE e l6 --3 Q.3 Mech. -7C-).Cr,
SPECIAL APPROVALS SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PRELIM. FINAL DATE Plan Check
Env.Health
SEPA
Planning
Modular/
Fire — MFG.Home
Prevent. a.
O
Engineer Other(Specify) v
W
Utilities Li
SEPA TOTAL $ Ca-
WHEN MACHINE VALIDATED IN THIS SPACE,
Plans PERMIT IS NONTRANSFERABLE THIS BECOMES A PERMIT.
Exam. PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
Building
ech ing IC`y_ IN 180 DAYS 1 (� -Q 3 –8j 3 9 4 0 °z 't 2 O. U U a
. J DATE ED PERMIT NO. TOTAL
a