1980, 12-04 Permit: 80B-4484 Wood StovePLAN NUMBER
(1)
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.
JOp DDRESS
x`1JA7 7OK g • 4 -c -'8N' �•(/"L(�fi\
LEGAL DESCRIPTION - SEE ATTACHED
PARCEL NUMBER/S
ERf
3.
AdDRESS
0 � i a..7 2/ 3 0.,0 ./� ,.� .p td -44..1..
CTITRACTOR
I
ADDRESS
4.
//244.4.1--
DESIGNER
lLDESIGNER
5.
ADDRESS
PHONE
92.6-667;2
ZIP
PHONE4
Actual Set Backs in Feet
North !South
East
'West
Size of Parcel 1 Zone Classification
ZIP
Type Const.
Occupancy
Sprinklered
❑Yes ❑No 0 Req'd.
PHONE
Valuation
Building Area in Sq. Ft.
ZIP
Main Floor
Upper Floors 1 Garage Area
Storage
CHANGE OF USE FROM
6.
TO
Area of Decks
Finished Basement
Unfin. Basement
TYPE
7. OF
WORK
❑ NEW
O BLD.
❑ ALT.
❑ PLMB.
❑ AD'N.
• MECH.
❑ RPL.
O M.H.
❑ MVE.
❑ POOL
0 OTHER
No. Baths
No. Stories
No. Rooms
No. of Dwellings
CERTIFICATE
of EXEMPTION
Req'd.
Rec'd.
Not Req'd.
D CRIBE WORK
8.
VALUATION
9.
SOURCE
OF
UTILITIES
G S
ELECTRIC
WATER
SEWER
Enum. Dist.
Ownership
Public ❑ Private ❑
Location (Area)
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 1.2-"—ei SIGNATURE OF APPLICANT-49,n—u.42-1
SPECIAL APPROVALS
NAME DATE
Env. Health
f'13n;1:'
Fire Marshall
it
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
B din Te nic
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
--1
$ �7
PERMIT NUMBER
ge/3— 18 L
04* *7.00
*7.00
*7.008
A *Q00
448.38
12-04-80
6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
121444
`O
DATE SSUED
448.4= *7. 0,0
PERMIT NO.