1983, 01-03 Permit: 83A-0032 Wood StovePLAN NUMBER APPL ICAT ION /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
STREET ADDRESS PARCEL NO.
LOT BLOCK SUBDIVISION LEGAL DESCRIPTION:
2.
OWNE PHONE C24 PHONE
3
Actual Set Backs in Feet to:
MAILING
D_QRESS !y�
G,I 7�� I 1
�r�
0✓ 2
North South East
West
TO
LICENSE EXPIRES
PHONE
Size of Parcel
Zone Classification
Residential❑
Commercial CI
CONI"'
� I
4.
�
ADDRESS
ZIP
Type Const. Occupancy
Sprinklered
❑Yes ❑No ❑Req'd.
PHONE
New Const. Valuation
Remodeled Valuation
Total Bldg. Floor Area
DESIGNER
5.
ZIP
Main Floor Upper
Floors
Garage/Storage
Greenhouse
ADDRESS
Cover Deck
Uncv. Deck
Fin. Basement
Unfin. Basement
CHANGE OF USE FROM
TO
6.
No. Baths No.
Floors
No. Fin. Rooms
No. Dwellings
TYPE ANEW ❑ALT. ❑ AD'N. C RPL.
C MVE.
7.
OF f
MECH. C M. H.
C OTHER
POOL
Certifi. of Exempt.
Required
Yes: ii No-
Number
WORK El BLD. El PLMB�CJ
or Variance
Received
YesC Non
Shorelines/ Flood Hazard
Plans Required C
8
DESC BE WORKa
16,
YesC NotApplic. C
Received _
VALUATION
SOURCE
GAS
ELECTRIC
WATER
PUBLIC ❑
SEWAGE
SEPTIC_
Ownership
FEES COLLECTED
9•
UTILLIITIES
PRIVATE ❑
SEWER
Public Private C
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 pr visions of a other state or local law regulating construction or the performance
of construction. SEE REVERSE EFORP,991MIRED
P TIONS
Plumbing
—� APPLICATION` =�
�? r
SIGNATURE OF
, DATE '
Mech
OWNER OR AGENT _
SPECIAL APPROVALS /
PRELIM. FINAL DATE
Env. Health
Planning
Prevent
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
PECIAL CONDITIONS;/(WE REVERSE SIDE FOR NOTICE)
PERMIT IS NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
Plan Check
SEPA
Modular/
PERMIT UMBER
MFG. Home >
CL
c
Other (Specify) LL
LL
TOTAL $
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATIASSUEl� 3— 8 3 PERMIT NO), 2 z
* 2 0, 0 0 if rAL