1980, 11-21 Permit: 80B-4100 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
z AT6
2.
4.
SUBDIVISION`—
OW ER f/ 0,
ADDRESS J
CONTRACTOR
9Q6'.(iYLf1;
ADDRESS
PHONE
9 -qs
LEGAL DESCRIPTION - SEE ATTACHED
PARCEL NUMBER/S
DESIGNER
5' ADDRESS
CHANGE OF USE FROM
6.
TO
ZIP
i g�fv
PHONE
ZIP
PHONE
ZIP
Actual Set Backs in Feet
North 'South East West
Size of Parcel
Zone Classification
Type Const.
Occupancy Sprinklered
❑Yes ❑No 0 Req'd.
Valuation
Building Area in Sq. Ft.
Main Floor
Upper Floors 1 Garage Area
Storage
Area of Decks
Finished Basement
Unfln. Basement
TYPE
7. OF
WORK
❑ NEW
❑ BLD.
D ALT.
O PLMB.pit
❑ AD'N.
MECH.
❑ RPL.
❑ M.H.
❑ MVE.
❑ POOL
❑ OTHER
No. Baths
No. Stories
No. Rooms
No. of Dwellings
CERTIFICATE
of EXEMPTION
Req'd.
9.
ESCRIBE WORK
VALUATION
SOURCE r
OF
UTILITIES
GAS
�
Enum. Dist.
Location (Area)
ELECTRIC W ER 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 ! J —2/ —Xd SIGNATURE OF APPLICAN
.4.,-s-eetta4i
SPECIAL A PPROVALS
NAME DATE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
Buil ingiech 'ciao
SPECIAL CONDITIONS:
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
Rec'd.
Not Req'd.
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL $ J
119
PERMIT NUMBER
04*
*7.00
*7.00 rri
409.92
11-21-80
6479
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
,,111 31401 0,
DATE ISSUED
4'10:0
PERMIT NO.
*7.000.► -
TOTAL
VII F rnPV