1979, 10-17 Permit: 79-6207 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 A
LEGAL DESCRIPTION - SEE ATTACHED
3
LOT
OWNER
ADDRES
BLOCK
SUBDIVISION
CONTRACTOR
4. ADDRESS
DESIGNER
5' ADDRESS
CHANGE OF USE FROM
6.
TYPE
7. OF
WORK
❑ NEW
O BLD.
O ALT.
O PLMB.
PaH.O/N E ry
3
ZIP
PHONE
ZIP
PHONE
ZIP
TO
❑ AD'N.
❑ MECH:
O RPL.
O M.H.
❑ MVE.
❑ POOL
0 OTHER
PARCEL NUMBER/S
Required Set Backs in Feet
North
South (East
West
Size of Parcel 1 Zone Classification
Type Const.
Occupancy Sprinklered
Dyes ❑No 0 Req'd.
Valuation (Building Area in Sq. Ft.
DWL Area
Split Entry
Basement Area
Garage Area
Storage
Split Level
Rancher
No. Baths
No. Floors
No. Rooms
Rec. Room
CERTIFICATE
of EXEMPTION
Req'd.
Rec'd.
Not Req'd.
DESCRIBE WORK
8.
VALUATION
9.
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 //2 —/ 7- 79 -
SIGNATURE
DEPT.
SPECIAL APPROVALS
REQ'D. REC'D.
Env. Health,
Planning
Fire Marshall
Co. Engineer
Utilities
Zone Clearance
SEPA Checklist
SPECIAL CONDITIONS:
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL
$
DATE
PERMIT NUMBER
79- �zo7
/ 7
04*
E
620,68
10-17-79
2 6.479,
*7.00
* 7.00
* 7.006
*000
WHEN MACHINE VALIDATED IN THIS SPACE,
/` / �j THIS B(E�COM S A PERMIT. [ 7 7 (�
DATFIy 1I — j�OFFICIAI �J��t./ L2 ''!% 1 Of ,i17 I— 7'9 Ur 2� 0, / z * /, U 0 (L F
APPROVED FOR ISSUANCE 7 -