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1983, 01-11 Permit 83A-0265 WoodstovePLAN NUMBER APPLICATION/PERMIT SPOKANE COUNTY — DEPARTMENT OF BUILDING & SAFETY NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675 STREET ADDRESS 1. S VAO LOT 2. BLOCK APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES SUBDIVISION OWNER 3. _5 ► �r� 1-ALt6 (-1E,S MAILING ADDRESS CONTRACTOR 4.ArnE ADDRESS rvIE DESIGNER 5. ADDRESS PHONE LICENSE EXPIRES CHANGE OF USE FROM 42ZPHONE -t tc7 P `-Lc( PHONE ZIP PHONE ZIP TO TYPE L( NEW ❑ ALT. ❑ AD' N. ❑ RPL. ❑ MVE. 7 OF WORK ❑ BLD. ❑ PLMB. C�"MECH. ❑ M.H. ❑ POOL ❑ OTHER PARCEL NO. LEGAL DESCRIPTION: Actual Set Backs in Feet to: North Size of Parcel South East Main Floor West Zone Classification Residential ❑ Commercial ❑ Spr'nklered :Yes ❑No ❑Req'd. Remodeled Valuation Upper Floors Garage/Storage 8. VALUATION 9. DE.CRIBE WORK c• e, SOURCE UTILITIES z GAS ELECTRIC WATER PUBLIC 0 PRIVATE 0 SEWAGE SEPTIC 0 SEWER 0 Cover Deck No. Baths Uncv. Deck No. Floors Certifi. of Exempt. or Variance Total Bldg. Floor Area Greenhouse Fin. Basement No. Fin. Rooms Required Yes❑ No❑ Received Yes ❑ No ❑ Shorelines/Flood Hazard Yes❑ Not Applic. 0 Ownership Public 0 Private 0 I hereby certify that I have read and examined this appl'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 th .revisions of any other state or local law regulating construction or the performance of construction. SEE REV SE IDE FOR REOUIRED,NSPECTIONS SIGNATURE OF OWNER OR AGENA SPECIAL APPROV PRELIM. FINAL DATE Env. Health Planning Fire Prevent. Engineer Utilities SEPA Plans Exam. Building Tech. APPLICATI9N C3 DATE f J` Q SPECIAL C DITIONS: (SEE REVERSE SIDE FOR NOTICE) PERMIT IS NONTRANSFERABLE PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED IN 180 DAYS Unfin. Basement No. Dwellings Number Plans Required 0 Received 0 FEES COLLECTED Building Plumbing Mech. Plan Check SEPA Modular/ MFG. Home Other (Specify) TOTAL $ PERMIT NUMBER Pt — WHEN MACHINE VALIDATED IN THIS SPACE, THIS BECOMES A PERMIT. DATL�IS9UE[ 1 — 8 3 PERMIT NZ.6, 5 5 *30,00°aOIAL