1980, 11-19 Permit: 80B-3953 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.
4.
JOB ADDRESS
l z tyy'lyy��,,yy
LOT BLOCK SUBDIVIS
LEGAL DESCRIPTION - SEE ATTACHED
OWrR R , ,\L1cr. z1iikMAt\I
ADDRESS
ji,A
CO NTR(�CT,31�
PHONE
PARCEL NUMBER/S
Actual Set Backs in Feet
North 'South East (West
Size of Parcel Zone Classification
ADDRESS
ZIP
Type Const. I Occupancy
Sprinklered
❑Yes ❑No ❑ Req'd.
DESIGNER
5' ADDRESS
PHONE
Valuation (Building Area in Sq. Ft.
ZIP
Main Floor
Upper Floors 1 Garage Area
Storage
CHANGE OF USE FROM
6.
TYPE
7. OF
WORK
TO
Area of Decks
Finished Basement
Unfin. Basement
IH NEW 0 ALT. 0�+AD N. 0 RPL. 0 MVE_
❑ BLD. ❑ PLMB. IId MECH. ❑ M.H. ❑ POOL
0 OTHER
No. Baths
No. Stories
No. Rooms
No. of Dwellings
CERTIFICATE
of EXEMPTION
Req'd.
Rec'd.
Not Req'd.
DESCRIBE WORK
8. klOG>b
Enum. Dist.
Location (Area)
VALUATION
9.
SOURCE
OF
UTILITIES
GAS
ELECTRIC
WATER
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 REVERSEGSIDE FOR REQUIRED INSPECTIO�NSS �� /
DATE OF APPLICATION /11/9/d 0 SIGNATURE OF APPLICANT (��r"�. ��"Z Lf.,14•"
SPECIAL APPROVALS
NAME DATE
Env. Health
Planning Ili
Fire Marshall
Co. Engineer
lit ilit les
Plans Examiner
SEPA Checklist
`uild'Mgait ian
SPECIAL CONDITIONS:
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
FEES COLLECTED
Single $
Building
Plumbing
7
op
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL $
PERMIT NUMBER
e3e71. - 3
04* *7.00
*7.00 ti
*7.006
A *000
3952
11-19-80
6479,
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
11+a -'8o
DATE ISSUED
3;9'5.38 *7.00FL) -
PERMIT NO. TOTAL