1980, 04-29 Permit: M80-4070 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.
JOB ADDRESS
S .z
LOT LOC
K
1 SUBDIVISION
LEGAL DESCRIPTION - SEE ATTACHED
OWNER
Ke.
ADDRESS
S. 3a
i3ufZkE
PHONE
z4 -34,v4
PARCEL NUMBER/S
C fiES
ZIP
c9 \ zoc
Actual Set Backs in Feet
North (South
East
(West
4.
CONTRACTOR
ONTRACTOR
ADDRESS
SONME
DESIGNER
5.
ADDRESS
PHONE
Size of Parcel
Zone Classification
ZIP
Type Const.
Occupancy
Sprinklered
❑Yes ❑No ❑ Req'd.
PHONE
Valuation
Building Area In Sq. Ft.
ZIP
Main Floor
Upper Floors
Garage Area
Storage
CHANGE OF USE FROM
6.
TO
Area of Decks
Finished Basement
Unfin. Basement
TYPE
7. OF
WORK
"NEW ❑ ALT. 0 AD'N.
0 BLD. 0 PLMB. Ell MECH.
❑ RPL.
O M.H.
❑ MVE_
❑ POOL
0 OTHER
No. Baths
No. Stories
CERTIFICATE
of EXEMPTION
J
No. Rooms
No. of Dwellings
Req'd.
Rec'd.
Not Req'd.
DESCRIBE WORK
8. We c 7 13ct2ry t�4 �7Tov6 lj/ YVlASO ft 'f
SOURCE GAS
OF
9. UTILITIES
VALUATION
ELECTRIC
WATER
1
Enum. Dist.
N(ri9MNEY
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 RREVERSE SIDE FOR REQUIRED INSPECTIONS /�/�
DATE OF APPLICATION ar T/g J SIGNATURE OF APPLICANT /..-t"/1/�G O
SPECIAL A'PROVALS SPECIAL CONDITIONS:
NAME DATE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
Buil 'n echnivan
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Horne
Other (Specify)
TOTAL $
PERMIT NUMBER
gyp- �47d
04*
*7.00
*7.00 tri
40698
04-29-80
Q 6.479,
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATE ISSUED
407,02
PERMIT NO.
*7,00°
TOTAL