1979, 10-11 Permit: 79-5766 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
LOT
BLOCK
SUBDIVISION
LEGAL DESCRIPTION — SEE ATTACHED
3.
OWNER
/ -' qs
ADDWS, iv
PHONE
528275"z
ZIP
29x3 7
PARCEL NUMBER/S
CONTRACTOR
4.
ADDRESS
DESIGNER
5. ADDRESS
PHONE
ZIP
CHANGE OF USE FROM
6.
TYPE
7. OF
WORK
❑ NEW
❑ BLD.
PHONE
ZIP
TO
❑ ALT. 0 AD N. 0 RPL. ❑ MVE.
❑ PLMB. MECH: 0 M.H. 0 POOL
0 OTHER
Required Set Backs in Feet
North (South [East (West
S
ize of Parcel
Type Const.
Zone Classification
Occupancy Sprinklered
❑Yes ❑No ❑ Req'd.
Valuation
Building Area in Sq. Ft.
DWL Area Basement Area Garage Area
Split Entry
No. Baths
Split Level
Storage
Rancher
No. Floors
No. Rooms
Rec. Room
CERTIFICATE
of EXEMPTION
Req'd.
Rec'd.
Not Req'd.
DESCRIBE WORK
• G�' TIO "7ocj�
LUATION Source
of
Utilities
9. 37767. CUG)
GAS
ELECTRIC
WATER
SEWER
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 constr ction or the
performance of construction.
DATE 0 2 SIGNATUR
DEPT.
SPECIAL APPROVALS
REQ'D. REC'D.
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Zone Clearance
SEPA Checklist
SPECIAL CONDITIONS:
DAT
r
APPROVED FOR ISSUANCE
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
7C} 6)
TOTAL $ 7. C%v
CSM
DATE
PERMIT NUMBER
�79
576.6)
04*
E
576,52
10-11-79
2 6479.
*7.00
*7.00 17.5
*7.006
*0.00
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
10-11'1'=7 9
5'76.65
*7,00 1
RECORD OF INSPECTIONS
DATE REMARKS
Final Inspection
INSPECTED BY
JG-JJ—,1c
C
*;CC
S(+U