1984, 02-10 Permit: 84A-1159 Wood StovePLAN 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
1.E.
STREET AD RESS
11
(ol 25,1
14
PARCEL NO.
LOT
2.
BLOCK
SUBDIVISION
LEGAL DESCRIPTION:
OWNER
3.
MAILGI�NG ADpf HESS -G '� Irl
CONTRt -1,6. 1�
4.
ON241.
PHONE
LICENSE EXPIRES
Zp ,�
�fy0
PHONE
Actual Set Backs in Feet to:
North 'South
Size of Parcel
11 Zone Classification
East
West
Residential 0
Commercial 0
ADDRESS
ZIP
Type Const.
Occupancy
Spr nklered
❑Yes ❑No ❑Req'd.
DESIGNER
5.
ADDRESS
PHONE
New Const. Valuation
Remode ed Valuation
Total Bldg. Floor Area
ZIP
Main Floor
Upper Floors
Garage/Storage
Greenhouse
6.
CHANGE OF USE FROM
TYPENEW
7• OF
WORK ❑ BLD.
TO
Cover Deck
Uncv. Deck
Fin. Basement
Unfin. Basement
❑ ALT. ❑ AD'N. ❑ RPL. ❑ MVE.
0 PLMB.MECH. 0 M.H. 0 POOL ❑OTHER
No. Baths
No. Floors
No. Fin. Rooms
No. Dwellings
Certifi. of Exempt.
or Variance
Required Yes No❑
Received Yes No❑
Number
DESCRIBE WORK
8. ao
VALUATION
9.
SOURCE
F
UTILLIITI ES
GAS
Shorelines/Flood Hazard
Yes Not Applic. ❑
Plans Required 0
Received 0
ELECTRIC
WATER
PUBLIC ❑
PRIVATE 0
SEWAGE
SEPTIC 0
SEWER 0
Ownership
Public 0 Private 0
I hereby certify that I have read and examined this app''cation 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 _SI E FOR REQUIRED INSPECTIONS
SIGNATURE OF
OWNER OR AGENT
SPECIAL APPROVALS
PRELIM. FINAL DATE
Env. Health
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
DATECATION /V94
SPE • CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PERMIT IS NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
FEES COLLECTED
Building
Plumbing
Mech.
Plan Check
SEPA
Modular/
MFG. Home
vo -
Other (Specify)
Zo.
TOTAL $
PERMIT NUMBER
4A-
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATE IS EDL 0 8 4
PERMITJNQ. 5. 9 z * 2 0, 0 0 iOµAL