1979, 10-03 Permit: M79-5243 Wood StovePLAN NUMBER
APPLICATION/PERMIT
SPOKANE COUNTY - BUILDING CODES DEPARTMENT
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / 1509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 4 COPIES
tBAD
DRESS
LO
2.
BLOCK
.
UBDI VISION
LEGAL DESCRIPTION - SEE ATTACHED
OWNER
3
AD MESS
tQ3 J
CONTRACTOR
4. Qc.1 /X y L.4
ADDRESS
DESIGNER
5' ADDRESS
PHONE
ZIP
PARCEL NUMBER/S
Required Set Backs in Feet
North 'South l.East (West
PHONE
Size of Parcel 1 Zone Classification
ZIP
Type Const.
Occupancy
Sprinklered
❑Yes ❑No 0 Req'd.
PHONE
Valuation (Building Area in Sq. Ft.
ZIP
DWL Area I Basement Area ` Garage Area
Storage
CHANGE OF USE FROM
6.
TO
Split Entry
Split Level
Rancher
TYPE
7. OF
WORK
❑ NEW
❑ BLD.
❑ ALT.
❑ PLMB.
O AD'N.
❑ MECH:
O RPL.
O M.H.
❑ MVE.
O POOL
0 OTHER
No. Baths
No. Floors
No. Rooms
Rec. Room
CERTIFICATE
of EXEMPTION
Req'd.
Rec'd.
Not Req'd.
DESCRIBE WORK
8. 4:.-.14 "/12_11---,
VALUATION
9.
vLl��, e-
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 .r t.e
performance of construction.
DATE /D —A 75SIGNATURE
DEPT.
SPECIALAPPROVALS
REQ'D. RECD.
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Zone Clearance
SEPA Checklist
SPECIAL CONDITIONS:
DATFfrJ-‘3-/ OFFICIA
APPROVED FOR ISSUANCE
FEES COLLECTED
Single S
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL
PERMIT NUMBER
7q-s�`7'3
DATE/e'_ -79
04*
E
524.2
10-03-79
2 61179.
*7.00
*7.00
*7.006
*000 0
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
10'..0 Y-7'9 542` 4,3 z
*7.002172
cc
cJ
w
0
UAL REMARKS
RECORD OF INSPECTIONS
Final Inspection
INSPECTED BY
- C
C1
S 0 0
Cu* 'SOC