1983, 12-21 Permit: 83B-2714 Wood Stove PLAN NUMBER APPLICATION/PERMIT PERMIT NUMBER
SPOKANE COUNTY - DEPARTMENT OF BUILDING &SAFETY ti L' -2:7I 1—
NORTH 811 JEFFERSON/SPOKANE,WASHINGTON 99260/(509)456-3675
APPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 3 COPIES
STREET ADDRESS, PARCEL NO.
1. 4-5 CO
LOT BLOCK SUBDIVISION LEGAL DESCRIPTION:
2. � � I�w �1�` l
3. OWE' "/ `�V CJ IA1I X PH '„ dJ�PHONEOK .,
L/�v /6 I
MAILING AD RES 'y Actual Set Backs in Feet to: •
t .• (ji �r ,7.2---1 _North South East I West
CONTRA Tcp) 6. LICENSE EXPIRES PHONE Size of Parcel Zone Classification Residential❑
4. /�JYL4'i�VO Commercial❑
ADDRESS ZIP Type Const. Occupancy Sprinklered
❑Yes ❑No ❑Req'd.
DESIGNER PHONE New Const.Valuation Remodeled Valuation Total Bldg.Floor Area
J. ADDRESS ZIP Main Floor Upper Floors Garage/Storage Greenhouse
CHANGE OF USE FROM TO Cover Deck T Uncv.Deck Fin.Basement Unf in.Basement
6.
No.Baths No.Floors No.Fin.Rooms No.Dwellings
TYPE H<IEW 0 ALT. D),0'N. ❑ RPL. ❑ MVE.
7. OF ❑ OTHER
WORK ❑ BLD. ❑ PLMB. MECH. ❑ M.H. ❑ POOL Certifi.of Exempt. Required Yes❑ No❑ Number
or Variance Received Yes No❑
DESCRIBEOSIK, Shorelines/Flood Hazard Plans Required❑
8. t -i'. G� ,e,' Yes Not Applic.❑ Received ❑
VALUATION SODURCE GAS ELECTRIC WAPUBTER
O E C SEWAGE Ownership FEES COLLECTED
9• UTILITIES PRIVATE❑ SEWER 0 Public 0 Private❑
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 .
-�
OWNER OR AGENT ` • .._ -e- -e-211-e- . -A- .:- - DATE r _ .7 '- Mech.
SPECIAL APPROVALS SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PRELIM. FINAL DATE Plan Check
Env.Health
SEPA
Planning Modular/
MFG.Home
Fire a-
Prevent. O
Other(Specify) v
Engineer W
J_
Utilities /) rJ_
TOTAL $ '
SEPA
PERMIT IS NONTRANSFERABLE WHEN MACHINE VALIDATED IN THIS SPACE,
Plans THIS BECOMES A PERMIT.
Exam. %k5t I PERMIT IS NULL AND VOID IF8 WORK HAS NOT COMMENCED
Tech. f. IN 180 DAYS — 2 1 —8 3 4o7 1.4 z° *2 aIlbtAL
DATE ED PERMIT