1980, 12-19 Permit: M80B-5103 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 3 COPIES
JOB ADDRESS �����
,. •1v
O iC BL SUBDI i4 r �1�
71/4)0 I
3.
4' ADDRESS
OWNER I
PLLVVO
ADrS? I Q1`
CO NTI1A
ZIP
LEGAL DESCRIPTION - SEE ATTACHED
PARCEL NUMBER /S 0794 5 — t
Actual Set Backs in Feet
North ✓ O 'South
PHONE
ZIP
Size of Parcel
787'c
Type Const.
V
Occupancy
DESIGNER
PHONE
Valuation
East
West
Zone Classification
Sprinklered
❑Yes ❑No ❑ Req'd.
Building Area in Sq. Ft.
5' ADDRESS
ZIP
Main Floor
Upper Floors
Garage Area
Storage
CHANGE OF USE FROM
TO
Area of Decks
Finished Basement
Unfin. Basement
TYPE
7. OF
WORK
/NEW ❑ ALT. 0 A�D'N. ❑ RPL. ❑ MVE.
L�l BLD. ❑ PLMB. E MECH. ❑ M.H. ❑ POOL
DESCRIBE WORK 000
❑ OTHER
No. Baths
No. Stories
No. Rooms
No. of Dwellings
CERTIFICATE
of EXEMPTION
Enum. Dist. I Location (Area)
Req'd.
Rec'd.
Not eq'd.
VALUATION SOURCE GAS ELECTRIC WATER SEWER
9. < '''-',00 �Q UTILITIES 62" SEPI'C
I 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 INSPECTIONS
Ownership
Public ❑ Private
USE CODE
DATE OF APPLICATION .4"‹- /2 /980
SIGNATURE OF APPLICANTAl-c11/9
SPECIAL APPROVALS
NAME DATE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
Build ing Tech
SPECIAL CONDITIONS:
1J . Get, ri J
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR .FROM DATE OF ISSUANCE
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
'Q 00
7 peg
TOTAL $ 17 '
�
IrPERMIT NUMBER
I
IgC.6_ rtC''1
02*
*1000
*1000
510,12
12- 19` -8Q
6479
u4* *7,00
*700 5
510,2g
12 -19 -80
z 6479
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
1 &O 510'3 *17.002 pi
DATE ISSUED PERMIT NO.
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