1981, 10-27 Permit: 81A-9109 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
1.
2.
3.
4.
JO ADDRESS
N _
LOT BLOCK
LEGAL DESCRIPTION - SEE ATTACHED
SUBDI V ISIO't
OWNER_ 2
AI-L
E_!sic30(0 fr‘i/1-11.4
ADDR
CONTRA T
ADDRESS
v 0
PHONE
742 1
PHONE
PARCEL NUMBER /S
Actual Set Backs in Feet
North [South
East (West
Size of Parcel I Zone Classification
ZIP
Type Const.
Occupancy
Sprinklered
ales ❑No ❑ Req'd.
DESIGNER
5' ADDRESS
PHONE
Valuation (Building Area in Sq. Ft.
ZIP
Main Floor
Upper Floors
Garage Area
Storage
6.
CHANGE OF USE FROM
TO
Area of Decks
Finished Basement
Unfin. Basement
TYPE
7. OF
WORK
E NEW ❑ ALT. ❑ AD,'N. ❑ RPL. ❑ MVE.
❑ BLD. ❑ PLMB. L7 MECH. ❑ M.H. ❑ POOL
❑ OTHER
No. Baths
No. Stories
No. Rooms
No. of Dwellings
DESCIRIB 9
8. ,V•v1 �,
CERTIFICATE
of EXEMPTION
Enum. Dist. I Location (Area)
Req'd.
Rec'd.
Not Req'd.
9.
VALUATION
SOURCE
OF
UTILITIES
GAS
ELECTRIC
WATER
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 constru tion or the
performance of construction. SEE REVERSE SIDE FOR REQUIRED INSPECTION I s
O
/DATE OF APPLICATION %1 ` 7 — d /
SPECIAL APPROVALS
NAME DATE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examine
SEPA Checklist
Builca g T cian
SIGNATURE OF APPLICAN
SPECIAL CONDITIONS:
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL
17 ,
$ 17-
PERMIT NUMBER
'51A _ 7107
04* *17,00
* 1 7,00
910.82
09-10-81
6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
0'9! -1.1 O,'- 8 t1
DATE ISSUED
910.9Z *17,0'021-2
PERMIT NO. TOTAL