1983, 02-10 Permit: 83A-0985 Wood Stove PLAN NUMBER APPLICATION/PERMIT PERMIT NUMBER01
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 PARCEL NO.
1. .74tI qT►
LOT BLOCK SUBDIVISION LEGAL DESCRIPTION:
2.
OWNER PHONE PHONE
3. .1Vi v11.(e. _S . A\i l vJ. c s 4,s(04:3-7•A0
MAILING ADDRESS ZIP Actual Set Backs in Feet to:
/!�c, 1.lac
t� Qa7.Q4- North 'South East I West
CONTRACTOR LICENSE EXPIRES PHONE Size of Parcel Zone Classification Residential
Commercial 0
4• C .6- ZIP Type Const. Occupancy Sprinklered
ADDRESS ❑Yes ONo ❑Req'd.
��1�Nn
DESIGNER PHONE New Const.Valuation Remodeled Valuation Total Bldg.Floor Area
5. -
ADDRESS ZIP Main Floor Upper Floors Garage/Storage Greenhouse
CHANGE OF USE FROM TO Cover Deck Uncv.Deck Fin.Basement Unf in.Basement
s. No.Baths No.Floors No.Fin.Rooms No.Dwellings
TYPE I NEW 0 ALT. 0 AD'N. 0 RPL. 0 MVE. ❑ OTHER
WORK . M.H.7' 0 BLD. 0 PLMB. MECH ❑ MH ❑ POOL Certifi.of Exempt. Required Yes No❑ Number
or Variance Received Yes Non
TRIBE WORK Shorelines/Flood Hazard Plans Required 0
8. Vs ce C�3 Yea❑ Not Applic.0 Received 0
VALUATION SOURCE GAS ELECTRIC WATER SEWAGE Ownership FEES COLLECTED
9.
OF
UTILITIES PUBLIC❑
PRIVATE❑ SEPTIC❑
SEWER❑ 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 •the e o local law regulating construction or the performance Plumbing
of construction.SEE REVE SIDE FOR RE fir I D I -P,•'CTIO%'
SIGNATURE OF �, / DATECATION� ) ,a� -*2.0� ,�
OWNER OR AGEN ✓.f L4411f..,' � .IA1; Mech.
SPECIAL APPROVALS SPECIA'CONDITI r)'S: (SEE REVERSE SIDE FOR NOTICE) Plan Check
PRELIM. FINAL DATE
Env.Health SEPA
Planning Modular/
MFG.Home
Fire 0Prevent. i.3
Other(Specify) W
Engineer J
�
Utilities . •0U
TOTAL $ t)
SEPA
WHEN MACHINE VALIDATED IN THIS SPACE,
PERMIT IS NONTRANSFERABLE THIS BECOMES A PERMIT.
Plas
Exanm PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED n p
Tech mg P9.qD IN 180 DAYS DATE ISSI2ED 3 PERMIT N09 8.5 5 * 2 O' O °�TXL