1983, 09-15 Permit 83A-9060 WoodstoveSIGNATURE OF +A A -
OWNER OR AGENT
r'LAN NUM[StH
AI-PLIICATtOI /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
1 ST;EETATRESSa ISco J - 'O
LOT BLOCK SUBDIVISION
2.
3.
4.
OWE fjrER &_ w'V7 'v✓ J
MAILING % 1 '
COAC t LICENSE EXPIRES
ADDRESS
7 ;:)I2F , � PHONE
dy
PHONE
ZIP
PARCEL NO.
LEGAL DESCRIPTION:
Actual Set Backs in Feet to:
North [South
Size of Parcel
Type Const.
Occupancy
East
West
Zone Classification
Residential 0
Commercial ❑
Spr'nklered
❑Yes ❑No ❑Req'd.
DESIGNER
5.
ADDRESS
CHANGE OF USE FROM
6.
TYPE / EW
7• OF LJ BLD.
WORK
PHONE
ZIP
TO
❑ ALT. ❑ AD' N. ❑ RPL. ❑ MVE.
❑ PLMB. �MECH. ❑ M.H. ❑ POOL
❑ OTHER
8. V�U✓
DEScnc:F�tS„
v
VALUATION
9.
SOURCE
UTILITIES
GAS
ELECTRIC
WATER
PUBLIC 0
PRIVATE 0
SEWAGE
SEPTIC 0
SEWER ❑
NewConst. Valuation
Remode ed Valuation
Total Bldg. Floor Area
Main Floor
Upper Floors
Garage/Storage
Greenhouse
Cover Deck
Uncv. Deck
Fin. Basement
Unfin. Basement
No. Baths
No. Floors
No. Fin. Rooms
No. Dwellings
Certif I. of Exempt.
or Variance
Required Yes❑ No❑
Received Yes❑ Nor]
Number
Shorelines/Flood Hazard Plans Requ red 0
Yes Not Applic. ❑ Received ❑
Ownership
Public 0 Private 0
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
work will be compiled 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 SI ' E FOR REQUIRED INSPECTIONS
I
SPECIAL APPROVALS
SPE(
PRELIM. FINAL DATE
Env. Health
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
V7Af-
APPLICATION 1
DATE ��1
IAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PERMIT IS NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
FEES COLLECTED
Building
Plumbing
Mech.
Plan Check
SEPA
Modular!
MFG. Home
Other (Specify)
TOTAL $
PERMIT NUMBER ,,�
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
09:15-8'3 I��Oz
DATE ISSUED PERMIT
*30.00ibr►L