1983, 09-15 Permit: 83A-9080 Wood Stove PLAN NUMBER APPLICATION/PERMIT PERMIT NUMBER
SPOKANE COUNTY - DEPARTMENT OF BUILDING & SAFETY s3 A cl°R;r0
C NORTH 811 JEFFERSON /SPOKANE,WASHINGTON 99260/(509)456-3675
APPLICANT:COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
STREET ADDRESS PARCEL NO.
1. 1Q 2 jL,0 3 11( kA „
LOT BLOCK SUBDIVISION LEGAL DESCRIPTION:
2.
OWN PHONE PHONE
3. ri a to AAS t rie n 9`Z8.39q Z
MAILING ADDRESS t , ZIP Actual Set Backs in`Feet to:
t 2.(+t� �J fid* ' (�* 192_12_ North 'South [East I West
CONTRACTOR LICENSE EXPIRES PHONE Size of Parcel Zone Classification Residential
SA I A, ., Commercial❑
4. ADDRESS ZIP Type Const. Occupancy Sprinklered ii !!
❑Yea ❑No ❑Req'd.
DESIGNER PHONE New Const.Valuation Remodeled Valuation Total Bldg.Floor Area
5. - r
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
TYPE EW ❑ ALT. ❑ A . ❑ RPL. ❑ MVE.
7. OF ❑ OTHER
WORK
El BLD. ❑ PLMB. ECH. ❑ M.H. DI POOL Certifi.of Exempt. Required Yes No❑ Number
or Variance Received Yes No❑
DESCRIBE WORK Shorelines/Flood Hazard Plans Required❑
8. 0em'D 13uorrY( Yes❑ Not Applic.❑ Received ❑
VALUATION SOURCE I GAS ELECTRIC WATER SEWAGE Ownership FEES COLLECTED
9. PUBLIC❑ SEPTIC El
PRIVATE D SEWER❑ Public❑Private❑
UTILILITIES
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 (�D / 17121/4.— _
APPLICATION 7/1 S 3 Mech.
OWNER OR AGENT �. .0 DATE r
SPECIAL APPROVALS SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PRELIM. FINAL DATE Plan Check
Env.Health
SEPA
Planning Modular/
Fire MFG.Home d
Prevent.
O
c.)
Engineer
Other(Specify) W
J
Utilities LL
JA
TOTAL $
SEPA
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 (,{� I N 180 DAYS (� 9 E 5 _8 3 �g 8 z * 2 ft o
Tech. I DATE4SSUED` PERM' N ITOITAL