1980, 01-06 Permit: 80-916 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 4 COPIES
JOB ADDRESS
1. 11.51, ‘5- A2 RD.
LOT
2.
BLOCK
SUBDIVISION
LEGAL DESCRIPTION - SEE ATTACHED
PARCEL NUMBER/S
OWNER
3. -.NNIS vt rzN‘SH
ADDRESS
N. St(S Bc L..‘v)A2 RO
C RACTOR
4.
me
PHONE
q 2.13 356t
ZIP
CrtZ.(40
Required Set Backs in Feet
North 'South lEast 'West
PHONE
Size of Parcel 1 Zone Classification
ADDRESS
ZIP
Type Const.
Occupancy
Sprinklered
❑Yes ❑No ❑ Req'd.
DESIGNER
5' ADDRESS
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.
0 ALT. ❑.( AD N. 0 RPL. 0 MVE.
❑ PLMB. Ipl MECH: ❑ M.H. 0 POOL
0 OTHER
No. Baths
No. Floors
No. Rooms
Rec. Room
CERTIFICATE
of EXEMPTION
Req'd.
Rec'd.
Not Req'd.
DESCRIBE WORK
8. 11•)5`7 - WOO54 tJ
9.
VALUATION
Source
of
Utilities
GAS
ELECTRIC
WATER
SEWER
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 local law regulating constructio or the
performance o construction.
DEPT.
SIGNATURE
SPECIAL APPROVALS
REQ'D. RECD.
Er. +h
Planning
Fire Marshall
Co. Engineer
Utilities
Zone Clearance
SEPA Checklist
HOME OWNER'S WARRANTY YES
NO D
SPECIAL CONDITIONS:
DATE 2/4/86 OFFICIAL ej t /')
ISS�l
APPROVED F R ISSUANCE
FEES COLLECTED
Single $
Building
Plumbing
Mech. � 0
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL
$
ti.
PERMIT NUMBER
8O _g/k
DATE 216/f34,
P
7,DD
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
0`l-'0 6-°80' 41,62 *7,OOa�