1979, 10-11 Permit: M79-5703 Stove, ChimneyPLAN 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. -S°11 130
2.
JOB '; Si I�`
LOT 3BLOCK SUBDIVISION ✓
LEGAL DESCRIPTION - SEE ATTACHED
3.
4.
OWN4R
AD 3E
;21 50,
CONTRA9TOR
ADDRESS
PHONE
926-2-$3,-
ZIP
PHONE
PARCEL NUMBER/S
Required Set Backs in Feet II
North `South `East (West
Size of Parcel I Zone Classification
ZIP
Type Const.
Occupancy
Sprinklered
❑Ves ❑No 0 Req'd.
DESIGNER
5' ADDRESS
PHONE
Valuation I Building Area in Sq. Ft.
ZIP
DWL Area I Basement Area r Garage Area
Storage
CHANGE OF USE FROM
6.
TO
Split Entry
Split Level
Rancher
TYPE
7. OF
WORK
LLd NEW 0 ALT.
O BLD. 0 PLMB.
❑ AD N.
❑ MECH:
0 RPL.
H
❑ MVE.
O POOL
❑ OTHER
No. Baths
No. Floors
No. Rooms
Rec. Room
CERTIFICATE
of EXEMPTION
Req'd.
Recd.
Not Req'd.
SpRIBE
8' DEWWWV -;44,1
SI III ✓ VV✓
VALUATION Source
of
9. Utilities
4 SIV
GAS 1 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 correc . 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 /0/707 / 7
DEPT.
SPECIAL APPROVALS
REQ'D. RECD.
SIGNATURE
Env. Health
Planning '
Fire Marshall
Co. Engineer
'Utilities
Zone Clearance
• SEPA Checklist
SPECIAL CONDIT
S:
DATE iO 10 OFFI
APP .fS�. FOR ISSUANCE
FEES COLLECTED
Single ' $
Building
Plumbing
Mech
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL $
PERMIT NUMBER
C71
DATE
04*
*7.00
*7.00 rri
57023
10-11 -79
3 6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
10it;1 1.1-.7t9 517'0.3 z
•
•
* 7, 0,0 24 p'