1980, 12-09 Permit: M80B-4616 Wood StovePLAN NUMBER
APPLICATION/PERMIT
SPOKANE COUNTY — ROWING CODES DEPARTMENT
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3•COPIES
JOB ADDRESS
LL . - B.K
OT. BLOCK
2.
LEGAL DESCRIPTION — SEE ATTACHED
PARCEL NUMBER/S
3 . ,&.,
ADDRESS
e /41zza
PHONE
gzG-zoi7
CONTRACTOR
4. elf Atli
ADDRESS
Aid 42.1.4Len -
DESIGNER
5' ADDRESS
34flC CLe xC ? Qtit�
ZIP
99.1-/G
Actual Set Backs in Feet
North (South
East (West
PHONE
Size of Parcel 1 Zone Classification
ZIP
Type Const.
Occupancy Sprinklered
Oyes DNo 0 Req'd.
PHONE
Valuation 1 Building Area in Sq. Ft.
ZIP
Main Floor
Upper Floors 1 Garage Area
Storage
CHANGE OF USE FROM
6.
TO
Area of Decks
Finished Basement
Unfin. Basement
TYPE
7. OF
WORK
//ESC RIIBE �wi RK...
R. Ar UATI f.( SOURCE
VALUATION SOURCE
OF
9. UTILITIES
O NEW
❑ BLO.
O ALT.
❑ PLMB.
0 AD N.
81 MECH.
❑ RPL.
❑ M.H.
❑ MVE.
O POOL
0 OTHER
No. Baths
No. Stories
No. Rooms
No. of Dwellings
CERTIFICATE
of EXEMPTION
Req'd.
Rec'd.
Not Req'd.
/ GAS ELECTRItSEWER
Enum. Dist. I Location (Area)
Ownership
Public O Private 0
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 SIDE FOR REQUIRED INSPECTIO ,+
DATE OF APPLICATION J.0-9•—R'S SIGNATURE OF APPLICANT
SPECIAL APPROVALS SPECIAL CONDITIONS:
NAME DATE
Env. Healt
anning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
y`,
$ 7 ea
TOTAL
PERMIT NUMBER
to Ci- -54/4-
01i*
4/G
04* *7.00
*7.00
*7.006
A *0.00
461.52
12-09.-80
6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
l'aHe.;so.J8 0)
DATE ISSUED
461.6'Z.
PERMIT NO.
*R00?.
TOTAL
a
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U
W
J
Ls-
WHEN
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