1980, 02-04 Permit: 80-848 Wood Stove, ChimneyPLAN 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
1.
2.
3.
4.
JOB ADDRESS
i-770 g E. LILt
LEGAL DESCRIPTION - SEE ATTACHED
LOT
BLOCK
SUBDIVISION
e.; RE IVAJ Acf2-65
PARCEL NUMBER /S
OWNER
O6E27 STGIrU bvici..t
ADDRESS
CONTRACTOR
L4 ,.1
ADDRESS
PHONE
c( Z4 -e-vo6
ZIP
Required Set Backs in Feet
North 'South [East 'West
PHONE
Size of Parcel 1 Zone Classification
ZIP
Type Const.
Occupancy
Sprinklered
❑Yes ❑No ❑ Req'd.
DESIGNER
5' ADDRESS
PHONE
Valuation 1 Building Area in Sq. Ft.
ZIP
DWL Area I Basement Area Garage Area
Storage
CHANGE OF USE FROM
6.
TYPE
7. OF
WORK
TO
Split Entry
Split Level
Rancher
Zvi NEW
❑ BLD.
❑ 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. i ALL J ) To VC
VALUATION
9.
Source
of
Utilities
GAS
MASe,PJ
ELECTRIC
C y
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 aw regulating construction or the
performance of construction.
DATE — v
SIGNATU E
SPECIAL APPROVALS
DEPT. R REQ'D. REC'D.
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Zone Clearance
SEPA Checklist
HOME OWNER'S WARRANTY
YES O
NO ❑
SPECIAL CONDITIONS:
DATE -44/80 OFFICIAL�� / _Y
APPROVED FOR ISSUANCE f�
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
-7.00
TOTAL $ 7.00
fi
PERMIT NUMBER
80— 848
DATE 1./4/ (36
04* *7.00
*7.00
*7.000
E *0.00
84.7
02- 04 " -80
2 6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
0 2,` 0 4, -'8' 0' 8 4 8 5 *7. 0 '0 2
DATE REMARKS
,P-f6
RECORD OF INSPECTIONS
Final Inspection
INSPECTED BY
Qtr,16
OS-Okt-U
Ait*
C O
r1*-
4 s 00