1982, 10-06 Permit: 82A-9165 Wood StovePLAN NUMBER
APPLICATION/PERMIT
SPOKANE COUNTY — EUiLDING CODES DEPARTMENT
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
JOB ADDRESS
1. E..
'f " N6
LEGAL DESCRIPTION — SEE ATTACHED
LOT
2.
BLOCK (SUBDIVISION
PARCEL NUMBER/S
OWNER
3. LG�ry
ADDRESS
4.
5.
PHONE
� . eSOR a E
CONTRACTOR
SAVE
ZIP
dpi
PHONE
Actual Set Backs in Feet
North 'South East (West
Size of Parcel Zone Classification
ADDRESS
DESIGNER
ZIP
Type Const.
Occupancy Sprinklered
❑Yes ❑No ❑ Req'd.
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
I]7 NEW ❑ ALT. ❑ AD'N. ❑ RPL. ❑ MVE.
❑ BLD. ❑ PLMB. L'MECH. ❑ M.H. ❑ POOL
❑ OTHER
No. Baths
No. Stories
No. Rooms
No. of Dwellings
CERTIFICATE
of EXEMPTION
Req'd.
Rec'd.
Not Req'd.
DESCRIBE WORK
8. VJN'
VALUATION
9.
SOURCE
OF
UTILITIES
Enum. Dist.
STo �1�
'Location (Area)
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 REVERSE�pSIDE FOR REQUIRED INSPECTIONS
_ f�
DATE OF APIfL'ICATI01`�i.._)D_( — 0 C� SIGNATURE OF APPLICANT " `1 ' (/1-" dCY -I
SPECIAL APPROVALS SPECIAL CONDITIONS:
NAME DATE
4
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
Building T hnician
PERMIT IS NONTRANSFERABLE
FEES COLLECTED
Single $
Building
Plumbing]
Mech. Ir26.00
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL $ cC'
ityti
PERMIT NUMBER
04* *20,00
*20006
A *000
916.4
10-06-82
z 6.479,
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
1'0-06-82
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE DATE ISSUED
91652 *20,00a�-
PERMIT NO. TOTAL