1983, 01-28 Permit: 83A-684 WoodstoveNUMBER APPLICATION/PERMIT PERMIT NUMBER
SPOKANE COUNTY — DEPARTMENT OF BUILDING & SAFETY r` -'�
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES —PRESS HARD TO MAKE 3 COPIES
STREET ADDRESS PARCEL NO.
2.
Lo BLOCK SUBDIVISION LEGAL DESCnIPTION:
Actual Set Backs in Feet to:
North South East West
Size of Parcel ZoneClassificationResidential ❑
Commercial ❑
Type Const. Occupancy Sprinklered
❑Yes ❑No ❑Req'd.
New Const. Valuation Remodeled Valuation Total Bldg. Floor Area
Main Floor Upper Floors i Garage/Storage Greenhouse
Cover Deck Uncv. Deck Fin. Basement Unfin. Basemf
OWNER
No. Baths
No. Floors
No. Fin. Rooms
PHONE
PHONE
1:1 MVE.
L> G
Fes=
(�,
7• OFD
OTHER
3.
I
Certifi.ofExempt.
Required
YesC NoC
Number
MAILING ADDRESS
r-5
6
P
Received
r I Pox
G-
DESC BE WO'RKShorelines/Flood
Hazard
CONTRACTOR�
dL9f� C/
Yes ❑ Not Applic. ❑
LICENSE EXPIRES
PHONE
4.
GAS
ELECTRIC
PUBLIC IJ
SEPTIC SEWAGEWATER
Ownership
FEES COLLECTED
ADDRESS
UTILITIES
ZIP
PRIVATE El
DESIGNER
Public LlPrivate ❑
PHONE
5.
reverse side, and know the same to be true and correct.
All provisions of laws and ordinances governing this type of
ADDRESS
work will be complied with whether specified herein or
not. The granting of a permit does not presume to give au-
ZIP
thority to violate or cancel the provisions of any other state
CHANGE OF USE FROM
TO
6.
SIGNATURE OF
APPLICATION —
OWNER OR AGENT r
Actual Set Backs in Feet to:
North South East West
Size of Parcel ZoneClassificationResidential ❑
Commercial ❑
Type Const. Occupancy Sprinklered
❑Yes ❑No ❑Req'd.
New Const. Valuation Remodeled Valuation Total Bldg. Floor Area
Main Floor Upper Floors i Garage/Storage Greenhouse
Cover Deck Uncv. Deck Fin. Basement Unfin. Basemf
:IAL CON
PRELIM. FINAL DATE
Env. Health
Planning
Prevent
ilities
(SEE REVERSE SIDE FOR NOTICE)
Plans PERMIT IS NONTRANSFERABLE
Exam. PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
Buipng ( IN 180 DAYS
L
i
Plan Check
SEPA
Modular/
MFG. Home
Other (Specify)
TOTAL $
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS oBElCOMES A PERMIT.
DATE ISSUED 2 8 _ z
PERMIT NO.
*20.00°
TOTAL
CL
C
C
LL
LL
No. Baths
No. Floors
No. Fin. Rooms
No. Dwellings
TYPE �f
, NE�/�/ ❑ALT. 1:1 AD'N. ❑RPL.
1:1 MVE.
7• OFD
OTHER
Certifi.ofExempt.
Required
YesC NoC
Number
WORK 1:1BLD. ❑ PLMB_0 MECH. ElM.H. ElPOOL
or Variance
Received
Yes ❑ Nor'.
DESC BE WO'RKShorelines/Flood
Hazard
Plans Required 1-18•
dL9f� C/
Yes ❑ Not Applic. ❑
Received ❑
VALUATION
9•
I SO— OURCE
GAS
ELECTRIC
PUBLIC IJ
SEPTIC SEWAGEWATER
Ownership
FEES COLLECTED
UTILITIES
PRIVATE El
SEWER ❑
Public LlPrivate ❑
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 SIPE FORAE49CRED INSPECTIONS
Plumbing
SIGNATURE OF
APPLICATION —
OWNER OR AGENT r
DATE f _
Mach.
:IAL CON
PRELIM. FINAL DATE
Env. Health
Planning
Prevent
ilities
(SEE REVERSE SIDE FOR NOTICE)
Plans PERMIT IS NONTRANSFERABLE
Exam. PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
Buipng ( IN 180 DAYS
L
i
Plan Check
SEPA
Modular/
MFG. Home
Other (Specify)
TOTAL $
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS oBElCOMES A PERMIT.
DATE ISSUED 2 8 _ z
PERMIT NO.
*20.00°
TOTAL
CL
C
C
LL
LL