1983, 12-06 Permit: 83B-2313 Wood StovePLAN NUMBER APPLICATION /PERMIT
SPOKANE COUNTY - DEPARTMENT OF BUILDING & SAFETY
NORTH 611 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 3 COPIES
STREETADDRESS PARCEL NO,,
LOT I BLOCK SUBDIVISION LEGAL DESCRIPTION:
2.
OWNER
PHONE
PHONE
K)E 1t— }A ,�\r,�.;-e ry
I
CkD —q
3.
-
MAILING ADDRESS T �
ZIP
Actual Set Backs in Feetto:
North South East
West
CONTRACTOR
LICENSE EXPIRES
PHONE
Size of Parcel
Zone Classification
Residential
c
\Me
Commercial El�
4.
ADDRESS
ZIP
Type Const.
Occupancy
Sprinklered
1s'Dl►yiE'
I
❑Yes ❑No ❑Req'd.
DESIGNER
PHONE
New Const. Valuation
Remodeled Valuation
Total Bldg. Floor Area
5.
ADDRESS
ZIP
Main Floor
per Floors
Garage/Storage
Greenhouse
CHANGE OF USE FROM
TO
Cover DeckUncv.
Deck
Fin. Basement
Unfin. Basement
6.
No. Baths No.
Floors
No. Fin. Rooms
No. Dwellings
TYPE NEW El ALT. ❑ �,D'N. 13 RPL. ❑ MVE.
7. OF ❑OTHER
WORK ❑ BLD. ❑ PLMB. MECH. ❑ M.H. ❑ POOL
Certifi. of Exempt.
Required
Yes❑ No❑
Number
or Variance
Received
Yes❑ No❑
DESCRIBE WORK
Shorelines/ Flood Hazard
Plans Required ❑
8.0 Z=. 0 �
Yes Not Applic. ❑
Received ❑
VALUATION
I SOOUFCE
GAS
ELECTRIC
WATER
PUBLIC ❑
SEWAGE
SEPT C ❑
I Ownership
FEES COLLECTED
9•
UTILITIES
PRIVATE ❑
SEWER ❑
Public ❑ Private ❑
1 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
work will be complied with whether specified herein or not. The granting of a permit does not presume to give au-
Building
thority to violate or cancel the provisions of any other state or local law regulating construction or the performance
of construction. SEE REVERSE SIDE FOR REQUIRED INSPECTIONS
Plumbing
SIGNATURE OF t APPLICATI N
OWNER OR AGEN DATE
Mach.�•'>
SPECIAL APPROVALS SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PRELIM. FINAL DATE
Env. Health
Planning
Utilities
SEPA
Plans I PERMIT IS NONTRANSFERABLE
Exam. PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
Building I I`�L I IN 180 DAYS
Tech.
Plan Check
SEPA
Modular/
MFG. Home
Other (Specify)
PERMIT NUMBER
TOTAL $ Z� I
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATEL�UEr,D 6 S 3 PERMIT'". 13 0
*20.00°&AL