1981, 03-25 Permit: 81A-2767 Wood StovePLAN NUMBER
(6
3/2 s/ 2/
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
✓
1. s�%,�f ,- /) -ii -(-61-e.---)./
LOTBLOCK SUBDLVISI N
2. 7 1 _0_46(2 ,4 i r_ id; Ze-6.dCD-
OWNER
3. Q rl.
AR ESS
c. /4P5.;,ate
CANT RAo R
}tea �'✓
4' ADDRESS
LEGAL DESCRIPTION - SEE ATTACHED
PHONE
77' -
ZIP
99' "7
PHONE
ZIP
PARCEL NUMBER/S �i,�-i/ —.C:LOr
3
� D r✓p zL 4 / dS
/.r1- / 5
Actual Set Backs in Feet
North 'South LEast 'West
Size of Parcel 1 Zone Classification
Type Const.
Occupancy
Sprinklered
❑Yes ❑No ❑ Req'd.
5.
DESIGNER
PHONE
Valuation Building Area in Sq. Ft.
ADDRESS
ZIP
Main Floor
Upper Floors
Garage Area
Storage
CHANGE OF USE FROM
6.
TO
Area of Decks
Finished Basement
Unfin. Basement
TYPE
7. OF
WORK
❑ NEW
❑ BLD.
❑ ALT.
❑ PLMB.
❑ AD'N.
Al MECH.
❑ RPL.
❑ M.H.
❑ MVE.
❑ POOL
❑ OTHER
No. Baths
No. Stories
No. Rooms
No. of Dwellings
CERTIFICATE
of EXEMPTION
Req'd.
Rec'd.
Not Req'd.
DESCRIBE )NO K j
ALUATION SOURCE GAS ELECTRIC WATER y
SEWER
9.UTILITIES
Enum. Dist. I Location (Area)
Ownership
Public ❑ Private ❑
USE CODE
I hereby certify that 1 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 r X /
SIGNATURE OF APPLICANT •
k
SPECIAL APPROVALS SPECIAL CONDITIONS:
NAME DATE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
Building ch
Tenici
_
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
FEES COLLECTED
Single $
,,P6Building /t
Plumbing
r )/7
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL $12, .
PERMIT NUMBER
S /A - 7 -7
.2*
* 1 0,00
* 1 0,00
2765
03-25-81
6479,
04*
* 1 7.00
* 17.00 t7i_
2766
03-25-81
6479,
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
,0'3j- 215.}-4'
276► 7z
DATE ISSUED PERMIT NO
7.00�
TOTAL
ru r nn nv