1980, 12-03 Permit: 80B-4409 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
JOB ADDRESS
LOT BLOCK O V 510
OWNER 4 PHONE
• 3. 11( - .61 -LL 9.2-.2 - / ADDRESS ZIP
s .o% f D q v., 41-ri .rf' . 44 - 99..D G
CCTOR PHONE
OTNV
4.
A D ^�R E_�St�S`l a�
DESIGNER
5' ADDRESS
CHANGE OF USE FROM
6.
TO
LEGAL DESCRIPTION - SEE ATTACHED
PARCEL NUMBER/S
ZIP
PHONE
ZIP
Actual Set Backs in Feet
North 'South East (West
Size of Parcel Zone Classification
Type Const.
Occupancy
Sprinklered
❑Yes ONO ❑ Req'd.
Valuation Building Area in Sq. Ft.
Main Floor
Upper Floors Garage Area
Storage
Area of Decks
Finished Basement
Unfin. Basement
TYPE
7. OF
WORK
❑ NEW
O BLD.
❑ ALT.
O PLMB.
❑ AD'N.
14 MECH.
O RPL.
O M.H.
❑ MVE.
❑ POOL
0 OTHER
No. Baths
No. Stories
No. Rooms
No. of Dwellings
CERTIFICATE
of EXEMPTION
Req'd.
Recd.
Not Req'd.
Enum. Dist.
Location (Area)
VALUATION SOURCE G S ELECTRIC WATER
OF
9. UTILITIES
SEWER
Ownership
Public ❑ Private 0
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 REVERSE SIDE FOR REQUIRED INSPECTIONS
DATE OF APPLICATION /2 - < '-Fe)
SIGNATURE OF APPLICANTl�� /davit"
SPECIAL APPROVALS SPECIAL CONDITIONS:
NAME DATE
Env, Health
Planning
Fire Marshall
Co. Englnee
Utilities
Plans Examiner
SEPA Checklist
B ding Tec icla
iner
�/✓� �� - - <Fd
PERMIT IS NONTRANSFERABLE
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Horne
Other (Specify)
TOTAL
PERMIT NUMBER
,!/75
'ilc9
04* *7,00
*7.00
*7.006
A *0.00 0
440.82
12-03-80
6479.
I
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
12 - B '�$ 0
4'.4a9z *7.000, -
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE DATE ISSUE[) PERMIT NO. TOTAL