1979, 10-23 Permit: M79-6515 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 Ap_DRESS f
V L -
LOT
BLOCK
SUBDIVISION
3
4. ADDRESS
OWN
E li 1 'A a,
ADDRESS
CONTRRyy�ACTOR 1 LO' 1( V�
5. ADDRESS
DESIGNER
CHAN .E OF SE FR
6.
M
TYPE
7, OF
WORK
NEW
❑ BLD.
PHON
'ZI P
ZIP
PHONE
ZI P
TO
❑ ALT. CII p'N. ❑ RPL. ❑ MVE.
❑ PLMB. AIMECH. ❑ M.H. ❑ POOL
❑ OTHER
LEGAL DESCRIPTION - SEE ATTACHED
PARCEL NUMBER/S
DESCRIBE WORK�
8. 14 W1Nal
VALUATION Source GAS
of
Utilities
9.
ELECTRIC
Required Set Backs in Feet
North
South
East Wes
Size of Parcel
Type Const.
Occupancy
Zone Classification
Sprinklered
❑Yes ❑No ❑ Req'd.
Valuation
Basement Area
Split Entry
No. Baths
Building Area in Sq. Ft.
Garage Area
Split Level
CERTIFICATE
of EXEMPTION
WATER
Storage
Rancher
No. Rooms
Req'd.
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 .:w regulating construction or the
performance of construction.
y Q�
DATE od
SIGNATURE
DEPT.
SPECIAL APPROVALS
REQ'D. REC'D.
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Zone Clearance
SEPA Checklist
SPECIAL CONDITIONS:
DATE
FFI
APPR
r
FOR ISSUANCE
Rec. Room
Rec'd.
Not Req'd.
FEES COLLECTED
Single $
Building
Plumbing
Mech.
?, 00
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL $
DATE
PERMIT NUMBER
04* *7.00
*7.00
*7,006
E *000 8
651,42
10-23-79
2 6479,
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES /i PERMIT.
1 01—X2151'-17'9. 6'5 1 5 z '* 7.0 0 °