1984, 01-13 Permit: 84A-392 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
STREET ADDRESS
1.
PARCEL NO.
LOT
2.
BLOCK
SUBDIVISION
LEGAL DESCRIPTION:
3.
OWNER
6) Pc Q. C-• •v,.: �4a
MAILING ADDRESS
4.
5.
CONTRACTOR
!a 121/404.0
PHONE
el
ADDRESS
�1✓VLL�
DESIGNER
LICENSE EXPIRES
PHONE
ADDRESS
6.
CHANGE OF USE FROM
ZIP
q4?—
PHONE
ZIP
PHONE
ZIP
TO
TYPE B'NEW ❑ ALT. ❑ AD' N. ❑ RPL. ❑ MVE.
7. OF
WORK ❑ BLD. 0 PLMB. Q MECH. ❑ M.H. ❑ POOL
❑ OTHER
Actual Set Backs in Feet to:
North (South [East I West
Size of Parcel
Zone Classification
Residential E
Commercial ❑
Type Const.
Occupancy
Sprinklered
❑Yes No ❑Req'd.
New Const. Valuation
Remodeled Valuation
Main Floor
Upper Floors
Garage/Storage
Total Bldg. Floor Area
Greenhouse
Cover Deck
Uncv. Deck
Fin. Basement
Unfin. Basement
No. Baths
No. Floors
No. Fin. Rooms
No. Dwellings
Certifi. of Exempt.
or Variance
Required Yes❑ No❑
Received Yes El Noll
Number
DESCRIBE WORK
8. ( '0.16
Shorelines/Flood Hazard
Yes Not Applic. C
VALUATION
9.
SOURCE
OF
UTILITIES
GAS
ELECTRIC
WATER
PUBLIC ❑
PRIVATE El
SEWAGE
SEPTIC El
SEWER 0
Ownership
Public Private D
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 state or local law regulating construction or the performance
of construction. SEE REVER SIDE FOR REQUIRED INSPECTIONS
SIGNATURE OFAPPLICATIQN
OWNER OR AGEN J DATE 7� (— I )
SPECIAL APPROVALS SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PRELIM. FINAL DATE
Env. Health
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
17/5
PERMIT IS NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
Plans Required ❑
Received 7
FEES COLLECTED
Building
Plumbing
Mech.
Plan Check
SEPA
Modular/
MFG. Home
ey
Other (Specify)
TOTAL $
PERMIT NUMBER
04* *2000
9.1 0
01-13-84
6479
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATEQS4UEDL 3 - 0 4
PERMIT NI 9. 2 z * 2 ft O O IOTAL