1983, 01-07 Permit: 83A-0158 Wood Stove PLAN NUMBER APPLICATION/PERMIT PERMIT NUMBER
SPOKANE COUNTY - DEPARTMENT OF BUILDING & SAFETY S3/1\ ` 0 I-5b
NORTH 811 JEFFERSON/SPOKANE,WASHINGTON 99260/(509)456-3675
APPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 3 COPIES
STREET ADDRESS PARCEL RCEL NO.
e Io 0� 94�
LOT BLOCK SUBDIVISION LEGAL DESCRIPTION:
2.
OWNER PHONE PHONE
Th & SLAC-1'-- LIZ'4•ozct
3. MAILING ADDRESS /� ZIP Actual Set Backs in Feet to:
Q
E.. t`.s(OZA
I LAC _ North South East `West _: L;. * " - ' `'
CONTRACTORr L•fe ttrSte� IR
XPCS PHONE c t�- Size of Parcel Zone Classification Residential❑ ,*r 4
4. �p'� / 'B J'e-d: (_ict4'\Ga..v �� ZZ` t 2 St, Commercial❑ i
ADDRESS ZIP Type Const. Occupancy Sprinklered i-,
❑Yes OW ❑Req'd.
DESIGNER PHONE New Const.Valuation Remodeled Valuation Total Bldg.Floor Area 1 .; ? -
5. ADDRESS ZIP Main Floor Upper Floors Garage/Storage Greenhouse
F
CHANGE OF USE FROM TO Cover Deck Uncv.Deck Fin.Basement Unfin.Basement
6. No.
7 TYPE SEW ❑ ALT. 0 AD'N. CI RPL. ❑ MVE. ❑ OTHER Baths No.Floors No.Fin.Rooms No.Dwellings
WORK
0 BLD. ❑ PLMB. MECH. ❑ M.H. ❑ POOL Certlfi.ofExempt. Required Yes❑ No❑ Number
or Variance Received Yes No❑
8. DESCRIBE WORK y Shorelines/Flood Hazard Plans Required❑
1,K,!O G i G 0 a Yes❑ Not Applic.❑ Received ❑
VALUATION SOURCE GAS ELECTRIC WATER SEWAGE Ownership FEES COLLECTED
9. OF
UTILITIES PUBLIC❑ SEPTIC❑
PRIVATE❑ SEWER❑ Public❑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 whetbe, specified herein or not. The granting of a permit does not presume to give au-
thority to violate or cancel the • a ' ions of any er state or local law regulating construction or the performance
of construction.SEE REVER SIDE •R RE ED INSPNS Plumbing
SIGNATURE Off' 1 APPLICATION /.., 7 �—
OWNER OR AGENT, �/' DATE Mech.
SPECIAL AP OVA /AL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
e Plan Check
PRE FINAL DATE
Env.Health
SEPA
Planning
Modular/
Fire MFG.Home >-
Prevent. a
O
Engineer Other(Specify) W
-J
Utilities 2.0
TOTAL $
SEPA
PERMIT IS NONTRANSFERABLE WHEN MACHINE VALIDATED IN THIS SPACE,
Plans THIS BECOMES A PERMIT.
Exam. PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED (� 1 (� 1
Tech. ,/7 IN 180 DAYS DATE ISSUED r_S 3 PERMIT N®.5. z * 2 O. Q T-MAL
Tech.