1983, 11-04 Permit: 83B-1322 WoodstovePLAN NUMBER
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
1.
STREET ADDRESS
5•` 1111 t0r�
PARCELoNO.
LOT
2.
BLOCK
SUBDIVISION
3
4.
OWNER
'.691V1 Ni
MAILING ADDRESS
P ONF
PHONE
LEGAL DESCRIPTION:
CONTR�
ADDRESS
ZIP 2_� C•4?
Actual Set Backs in Feet to:
North 'South I East I West
LICENSE EXPIRES
PHONE
Size of Parcel
Zone Classification
Residential ❑
Commercial ❑
ZIP
Type Const.
Occupancy
Sprinklered
Les ❑No Req 'd.
DESIGNER
5.
ADDRESS
PHONE
New Const. Valuation
Remodeled Valuation
Total Bldg. Floor Area
ZIP
Main Floor
Upper Floors
Garage/Storage
Greenhouse
CHANGE OF USE FROM
6.
TO
Cover Deck
Uncv. Deck
Fin. Basement
Unfin. Basement
O17PE fa'NEW ❑ ALT. AD'N. ❑ RPL. ❑ MVE.
7 OTHER
WORK ❑ BLD. ❑ PLMB.MECH. ❑ M.H. CIPOOL
No. Batts
No. Floors
No. Fin. Rooms
No. Dwellings
Certifi. of Exempt.
or Variance
Required YesD No❑
Received Yes El No
Number
DESCRIl�Op 2
8.
VALUATION
SOURCE
OF
UTILITIES
GAS
ELECTRIC
WATER
PUBLIC ❑
PRIVATE ❑
SEWAGE
SEPTIC ❑
SEWER ❑
Shorelines/Flood Hazard
Yes❑ Not Applic. ❑
Ownership
9. Public D Private 0
I hereby certify that 1 have read and examined this appl'cation 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 •e provisions of a • - = focal aw regulating construction or the performance
of construction. SEE RE _ SE SIDE FO
SIGNATURE OF
OWNER OR AGE
APPLICATION/
DATE
SPECIAL APPROVALS S CIAL CONDITIONS' EE REVERSE SIDE FOR NOTI E)
PRELIM. FINAL DATE
Env. Health
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
PERMIT IS NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
Plans Required ❑
Received ❑
FEES COLLECTED
Building
Plumbing
Mech.
Plan Check
SEPA
Modular/
MFG. Home
Other (Specify)
c°
TOTAL $
PERMIT NUMBER
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
_. 132.22 *20.00°
�
DATE ISSUED PERMIT NO. TOTAL