1983, 02-10 Permit: 83A-0983 WoodstoveNo. Fin. Rooms
PLAN NUMBER
APPLICATION/PERMIT
SPOKANE COUNTY — DEPARTMENT OF BUILDING & SAFETY
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES - PRESS HAFD TO MAKE 3 COPIES
STREET ADDRESS
1. C. 13k+
LOT BLOCK
2.
OWNER
SUBDIVISION
MAILING ADDRESS
. ?3't
STH
4.
CONTRACTOR
ADDRESS
PHONE
LICENSE EXPIRES
DESIGNER
5.
ADDRESS
CHANGE OF USE FROM
6.
PHONE
Ct: 'a34:4'4
ZIP
PHONE
ZIP
PHONE
ZIP
TO
TYPE Q"NEW ❑ ALT. ❑ D' N. ❑ RPL. ❑ MVE.
7. OFWORK ❑ BLD. 0 PLMB. E! MECH. T M.H. ❑ POOL ❑OTHER
PARCEL NO.
LEGAL DESCRIPTION:
Actual Set Backs in Feet to:
North South East I West
Size of Parcel
Type Const. Occupancy
New Const. Valuation
Main Floor
Zone Classification
Residential C
Commercial ❑
Spr'nklered
❑Yes ❑No Req 'd.
Remode ed Valuation
Upper Floors Garage/Storage
DECRIBE WORK
• 1hiQG'0`S1-0QE
VALUATION
9.
SOURCE
OF
UTILITIES
GAS
ELECTRIC
WATER SEWAGE
PUBLIC C SEPTIC 0
PRIVATE ❑ SEWER ❑
Cover Deck
No. Baths
Certifi. of Exempt.
or Variance
Uncv. Deck
No. Floors
Total Bldg. Floor Area
Greenhouse
Fin. Basement
Required Yes No❑
Received Yes❑ No7
Shorelines/Flood Hazard
Yes ❑ Not Applic. 0
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 state or local law regulating construction or the performance
of construction. SEE REVERSE SIDE FOR REQUIRED INSPECTIONS
SIGNATURE OF / APPLICATION
OWNER OR AGENT %. T ��" ?L ATE / 2-" cf2 -3
SPECIAL APPROVALS
PRELIM. FINAL DATE
Env. Health
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PERMIT IS NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
I N 180 DAYS
Unfin. Basement
No. Dwellings
Number
Plans Required ❑
Received Cl
FEES COLLECTED
Building
Plumbing
Mech.
Plan Check
SEPA
Modular/
MFG. Home
Other (Specify)
TOTAL $ Co
PERMIT NUMBER
3A - OctS�
*2000
*20.006
*000
9822
02-10-83
z 6479,
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATE is .i0. - 1 0 — 8 3 PERMIT NO.
9 8.3 5
*20.00°t-
TOTAL