1979, 12-04 Permit: M79-8678 Wood StovePLAN NUMBER
APPLICATION /PERMIT
SPOKANE COUNTY — BUILDING CODES DEPARTMENT
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456 -3675
APPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 4 COPIES
JOB ADDRESS
,. e gs ' i9 COI"-
LEGAL DESCRIPTION - SEE ATTACHED
LOT BLOCK SUBDIVISION
PARCEL NUMBER /S
OWNER
3. • t 11% tAJUI.'
DRESS
/ f � (7 iT�� 440424'
4042 4104
CONTRACTOR
PHONE
Required Set Backs in Feet
North
South East
West
PHONE
Size of Parcel Zone Classification
ADpRESS
4 /14.-
ZIP
Type Const.
Occupancy Sprinklered
❑Yes ❑No ❑ Req'd.
DESIGNER
PHONE
Valuation
Building Area in Sq. Ft.
ADDRESS
ZI P
DWL Area I Basement Area
Garage Area I Storage
6.
CHANGE OF USE FROM
TO
Split Entry
Split Level
Rancher
TYPE
7. OF
WORK
❑ NEW
❑ BLD.
El ALT.
❑ PLMB.
❑ AD'N.
MECH:
❑ RPL.
❑ M.H.
❑ MVE.
❑ POOL
❑ OTHER
No. Baths
No. Floors
No. Rooms
Rec. Room
CERTIFICATE
of EXEMPTION
Req'd.
Rec'd.
Not Req'd.
DESCRIBE WORK
8. Li'
VALUATION source
of
9. Utilities
r
GAS I EL CTRIC
WATER
SEWER
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 complied with whether specified herein or not. The granting of a permit does not presume
to give authority to violate or cancel the provisions of any other state or local law regulating construction or the
performance of construction. I /;
DATE %.x —7 71 SIGNATURE
1A%)
SPECIAL APPROVALS
DEPT. REQ'D. REC'D.
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Zone Clearance
SEPA Checklist
SPECIAL CONDITIONS:
—77 r y
DATE OFFICIAS42
APPROVED FOR ISSUANCE
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL
7
$ ? c__
PERMIT NUMBER
7/_ cf4, %w
DATE / —4-77
04* *7,00
*7.00 N
867.72
12 -04 -79
6479,
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES.A PERMIT.
121- 04 -.79 867,85
DATE REMARKS
RECORD OF INSPECTIONS
¥ 1 '!
Final Inspection
INSPECTED BY
r
J 5— Ott —,d
4,;0c 9
cct* .,1 00