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
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P
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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