1980, 01-09 Permit: 80A-9979 Wood StovePLAN ' 'JMBER
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
BLOCf)a0 DIVISQ 1 B
LEGAL DESCRIPTION - SEE ATTACHED
3.
4.
R ESSIT
DESIGNER f"axOS
5. ADDRESS
CHANGE OF USE FROM
6.
TYPE
7. OF
WORK
❑ NEW
❑ BLD.
❑ ALT.
❑ PLMB.
PHONE
ZI P
PHONE
ZI P
TO
❑ AD'N.
❑ MECH:
❑ RPL.
❑ M.H.
❑ MVE.
❑ POOL
❑ OTHER
PARCEL NUMBER/S
Required Set Backs in Feet
North
South
Size of Parcel
Type Const.
Occupancy
East
West
Zone Classification
Sprinklered
Oyes ❑No ❑ Req'd.
Valuation
No. Baths
Building Area in Sq. Ft.
Garage Area
Split Level
Storage
Rancher
CERTIFICATE
of EXEMPTION
Req'd
Rec. Room
Rec'd.
Not Req'd.
DESCRIBE WORK
8.
VALUATION
9.
Lk)p-cs&_
Source
of
Utilities
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 construction or the
performance of construction.
DATE SIGNATURE
DEPT.
SPECIAL APPROVALS
REQ'D. REC'D.
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Zone Clearance
SEPA Checklist
SPECIAL CONDITIONS:
% � c &
f S��
DATE Lam- (2l %OFFICIAL ft.\Ct Akryx.CyVO
APPROVED FOR ISSUANCE
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL $
PERMIT NUMBER
qa- A - c q1 \
DATE
* *7.00
*7.00 N
*7008
E *0.00
997.82
01-09-80
-Q 6,479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THISTFCj_O lE9SA nMIT.
99792 *7,00°�