1983, 10-05 Permit: 83A-9974 WoodstovePLAN NUMBER
APPLICATION/PERMIT
SPOKANE COUNTY — DEPARTI1n,GNT_OF BUILDING & SAFETY
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 3 COPIES
STREFT ADDRESS
1.
PARCEL NO.
LOT BLOCK SUBDIVISION
2.
LEGAL DESCRIPTION:
3.4q 6- J1 1)
MAILING ADDRESS
L2 o-2— i
CON14T
4. ADDRESS
PHONE
22-IGl3
LICENSE EXPIRES
PHONE
PHONE
Actual Set Backs in Feet to:
North South East 1 West
Size of Parcel
Zone Classification
Residential ❑
Commercial ❑
ZIP
Type Const.
Occupancy
Spr nklered
DYes ❑No ❑Req'd.
DESIGNER
5.
ADDRESS
PHONE
New Const. Valuation
Remode ed Valuation
Total Bldg. Floor Area
ZIP
Main Floor
Upper Floors
Garage/Storage
Greenhouse
6.
CHANGE OF USE FROM
TO
Cover Deck
Uncv. Deck
Fin. Basement
Unfin. Basement
TYPEEW
7. OF
WORK ❑ BLD.
❑ ALT. ❑ AD' N. ❑ RPL.
❑ MVE.
❑ PLMB.k? MECH. ❑ M.H. ❑ POOL
❑ OTHER
No. Baths
No. Floors
No. Fin. Rooms
No. Dwellings
Certifi. of Exempt.
or Variance
Required Yes❑ No El
Received Yes No El
Number
DESC, RI�W
8. r C
Shorelines/Flood Hazard
Vest: Not Applic. ❑
Plans Requ'red ❑
Received ❑
VALUATION
9.
SOURCE
UTILITIES
GAS
ELECTRIC
WATER
PUBLIC ❑
PRIVATE ❑
SEWAGE
SEPTIC ❑
SEWER ❑
Ownership
Public 0 Private 0
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
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 st. : or local law regulating construction or the performance
of construction. SEE REV RSE SIDE FOR REQUIRED SPEC` +NS
SIGNATURE OF O�Ia} _ j _ �v
OWNER OR AGENT DATE APPLICATI/(J V
SPECIAL APP(40V LS SPECIAL CONDITIONS: (SirE ; EVER�'E SIDE FOR NOTICE)
PRELIM. FIN L 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
FEES COLLECTED
Building
Plumbing
Mech.
Plan Check
SEPA
Modular/
MFG. Home
Other (Specify)
TOTAL $
.f—
PERM IT UMBER
1
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATEiSSUEU' 5 — 8
PERMIT 7N0. 7' z
*2 0.004o>=AL