1981, 12-21 Permit: 81B-2891 Wood Stoveiize of Parcel
(PLAN 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 ADD R S (} i5
LOT `B CI��SUBDIV4 Od
ON )l
OWNER
O TRACTOR
PHONE
PHONE
ADDR SS v O
DESIGNER ▪ 1 �
5.
ADDRESS
CHANGE OF USE FROM
6.
TYPE
7. OF
WORK
8.
El NEW
BLD.
D SCRIBE WORK
TO
PHONE
ZIP
LEGAL DESCRIPTION - SEE ATTACHED
PARCEL NUMBER /S
Actual Set Backs in Feet
North South East West
Type Const.
Occupancy
Valuation
Main Floor
Upper Floors
Area of Decks
Zone Classification
Sprinklered
❑Yes ❑No ❑ Req'd.
Building Area in Sq. Ft.
Garage Area
Storage
Finished Basement Unfin, Basement
❑ ALT. ❑ AD'N. ❑ RPL. ❑ MVE.
❑ PLMB. I4MECH. ❑ M.H. ❑ POOL
No. Baths
No. Stories
No. Rooms
❑ OTHER
CERTIFICATE
of EXEMPTION
Enum. Dist. Location (Area)
Req'd.
SOURCE
OF
TILITIES
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
ELECTRIk
WATER
SEWER
Ownership
Public ❑ Private ❑
USE CODE
DATE OF APPLICATION i'T
SPECIAL APPROVALS
NAME DATE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
SIGNATURE OF APPLICANT _- )tcr-i� -k..,
SPECIAL CONDITIONS:
PERMIT IS NONTRANSFERABLE
No. of Dwellings
Rec'd.
Not Req'd.
FEES COLLECTED
Single $
Building
Plumbing
▪ Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL
$ LY�
PERMIT NUMBER
�t
-2-621
04* * 1 7.00
* 1 7.00
* 17008
A *0.00
289.02
12 -21 -81
2 6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
1'2 -:2 `=81
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE DATE ISSUED
28915 *17,OOaI-
PERMIT NO. TOTAL
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