1979, 12-18 Permit: 79-9261 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
1.
2.
JOB ADDRESS
50 -
LOT
E3.0I^101 H
LEGAL DESCRIPTION - SEE ATTACHED
BLOCK
SUBDIVISION
OWNER
3 M170,0\115:21.4
M�°I—�j✓ 7
ADDRESS, ' JL I ✓' �
CONTJ2F�CTQF / 1
ADDRESS>S'1��/II �jV,
4.
F0-6,74-
ZIP
PARCEL NUMBER/S
Required Set Backs in Feet
North 'South
East
'West
PHONE
Size of Parcel
Zone Classification
ZIP
Type Const.
Occupancy
Sprinklered
❑Yes ❑No 0 Req'd.
DESIGNER
5' ADDRESS
PHONE
Valuation
Building Area in Sq. Ft.
ZIP
DWL Area I Basement Area
Garage Area
Storage
6.
CHANGE OF USE FROM
TO
Split Entry
Split Level
Rancher
TYPE
7, OF
WORK
ErtNEW 0 ALT.
0 PLMB.
❑ BLD.
❑ AD'N. ❑ RPL. ❑ MVE.
�,/
0 OTHER
LI MECH:❑ M.H. 0 POOL
No. Baths
No. Floors
No. Rooms
Rec. Room
CERTIFICATE
of EXEMPTION
Req'd.
Rec'd.
Not Req'd.
DES IBE WORK
8. /90 .io /
VALUATION
9.
Source
of
Utilities
GAS
ELECTRIC
WATER
SEWER
I hereby certify that I have read and
on reverse side, and know the same
type of work will be complied with
to give authority to violate or cancel
performance of construction.
DATE /�/ 5q/,J
examined this application and have read the "NOTICE" provisions included
to be true and correct. All provisions of laws and ordinances governing this
whether specified herein or not. The granting of a permit does not presume
the provisions of any other state or locale regulating c.: truction or the
SIGNATURE
SPECIAL APPROVALS
DEPT. REQ'D.
REC'D.
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Zone Clearance
SEPA Checklist
SPECIAL CONDITIONS:
DATE
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
7,00
TOTAL $
DATE
(l
PERMIT NUMBER
77-7 /
04* *7.00
*7.00 175
*7,006
E *0.00 8
92608
12-18-79
6479,
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT. 7 Q.Q O I -
A2 -1-8-79 9'26.15