1979, 11-02 Permit: 79-7210 Wood StovePLAN NUMBER
APPLICATION /PERMIT
SPOKANE COUNTY — BUILDING CODES DEPARTMENT
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456 -3675
DATE
APPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 4 COPIES
1.
2.
3.
4.
JOB ADDRESS /)
LOT BLOCK gg0 SUBDtke ( Q p
LEGAL DESCRIPTION - SEE ATTACHED
PARCEL NUMBER /S
OWNER
A£ IS 108 ikN✓{(E�.Y
CONTRACTOR
SAME
ADDRESS
PHONE
9138 aG31
ZI P
9q 2.C;(c>
Required Set Backs in Feet
North !South ',East (West
PHONE
Size of Parcel
Zone Classification
ZIP
Type Const.
Occupancy
Sprinklered
❑Yes ❑NO ❑ Req'd.
DESIGNER
5. ADDRESS
PHONE
Valuation
Building Area in Sq. Ft.
ZI P
DWL Area I Basement Area
IGarage Area I Storage
CHANGE OF USE FROM
6.
TYPE
7. OF
WORK
TO
Split Entry
Split Level
Rancher
NEW
❑ BLD.
❑ ALT. ❑ AD'N. ❑ RPL. ❑ MVE.
❑ PLMB. 'MECH. ❑ M.H. ❑ POOL
❑ OTHER
No. Baths
No. Floors
CERTIFICATE
of EXEMPTION
No. Rooms
Rec. Room
Req'd.
Rec'd.
Not Req'd.
DESCRIBE WORK
8.
if. S +ALL woo.D GI2UIU6 STOVE
9.
VALUATION Source
of
Utilities
GAS
ELECTRIC
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. q
DATE `" ) io7 SIGNATURE C" "� (/ - ! //,v /L �✓
SPECIAL APPROVALS SPECIAL CONDITIONS:
DEPT. REQ'D. REC'D.
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Zone Clearance
SEPA Checklist
DATE tZ7j
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
']0D
TOTAL $ i
PERMIT NUMBER
-77 - 7.21u
04*
* 7.00
* 7.00 tz
720.92
11 -02 -79
2 6,479,
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
11`'02. -79 7 2L0z
*700'
DATE REMARKS
. t
RECORD OF 'INSPECTIONS
e. f
*
Final Inspection
INSPECTED BY
.11-05—Ae
,1S0(1,1%
ct 4 X00