1981, 08-20 Permit: M81A-8349 Woodburning 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 3 COPIES
JOB ADDRESS
J�0 l\LA
LOT BLOCK
SUBDIVISION
OWNER
3 El(Z- 5► E1 Mc; lL
ADDRESS
CONTRACTOR
PHONE
f(? -ems
(A1.C" i .�
ADDRESS
DESIGNER
5. ADDRESS
CHANGE OF USE FROM
6.
TYPE
7. OF
WORK
LJ NEW ❑ ALT.
❑ BLD. ❑ PLMB.
ZIP
PHONE
LEGAL DESCRIPTION - SEE ATTACHED
PARCEL NUMBER /S
Actual Set Backs in Feet
North !South
East
West
ZIP
PHONE
ZIP
TO
El AD'N. ❑ RPL. ❑ MVE.
LJ MECH. ❑ M.H. ❑ POOL
❑ OTHER
Size of Parcel Zone Classification
Type Const.
Valuation
Occupancy
Sprinklered
Oyes ❑No ❑ Req'd.
Main Floor
Upper Floors
Area of Decks
No. Baths
Building Area in Sq. Ft.
Garage Area
Storage
Finished Basement Unfin. Basement
No. Stories
CERTIFICATE
of EXEMPTION
No. Rooms No. of Dwellings
Req'd. Rec'd.
DESCRIBE WORK
8. i.UCTTh (3, A 2N
VALUATION
9.
SOURCE
OF
UTILITIES
GAS
ELECTRIC
WATER
Enum. Dist. I Location (Area)
SEWER
Ownership
Public ❑ Private ❑
USE CODE
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. SEE REVERSE SIDE FOR REQUIRED INSPECTI NS
DATE OF APPLICATION() F-) 1
SIGNATURE OF APPLICA
SPECIAL APPROVALS
NAME DATE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
Buildin
ele
SPECIAL CONDITIONS:
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
Not Req'd.
FEES COLLECTED
Single $
Building
Plumbing
Mech. ' Cx)
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL
$ 17 -Cx.
it)
PERMIT NUMBER
Si i°t - S-5461
04* * 1 7.00
* 1 7,00
* 17008
A *000 8
834.88
08- 20-81
g 6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
10,,8 ^ . 0 T 8 '1
DATE ISSUED
PERMIT N6. 4.9 Z *1 74)TA�
U
W
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