1982, 05-26 Permit: 82A-4195 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 3 COPIES
1.
2.
3.
JOB ADDRESS
� -
15-c112, € Ro ki?
LEGAL DESCRIPTION - SEE ATTACHED
LOT
BLOCK
SUBDIVISION
OWNER
DALE- V
PHONE
Y'-336(9
PARCEL NUMBER/S
ADDRESS
15 t-'_ - 6Rthp
ZIP
`l9'.-i(a
Actual Set Backs in Feet
North 'South East 'West
CONTRACTOR
4. ADDRESS
PHONE
Size of Parcel 1 Zone Classification
ZIP
Type Const.
Occupancy
Sprinklered
❑Yes ❑No ❑ Req'd.
DESIGNER
5. ADDRESS
PHONE
Valuation Building Area in Sq. Ft.
ZIP
Main Floor Upper Floors
Garage Area
Storage
CHANGE OF USE FROM
6.
TYPE
7. OF
WORK
TO
Area of Decks
Finished Basement
Unfin. Basement
L�1 NEW ❑ ALT. ❑ AD'N. ❑ RPL. ❑ MVE.
❑ BLD. ❑ PLMB. E-11ECH. ❑ M.H. ❑ POOL
❑ OTHER
No. Baths
No. Stories
No. Rooms
No. of Dwellings
DESCRIBE WORK
8. W&OD 5Z0Ns-TA1 fc,Irl
VALUATION
9.
GAS
SOURCE
OF
UTILITIES
CERTIFICATE
of EXEMPTION
✓ Enum. Dist. I Location (Area)
Req'd.
Rec'd.
Not Req'd.
ELECTRIC
WATER
SEWER
Ownership
Public D 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 INSPECTIONS �j�
DATE OF APPLICATION s/as-1 O SIGNATURE OF APPLICANT C IN ,
SPECIAL APPROVALS SPECIAL CONDITIONS:
NAME DATE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
Building Technician
PERMIT IS NONTRANSFERABLE
FEES COLLECTED
Single $
Building
Plumbing
ou
Mech. ��Jr
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL
pe
$ zo'xu
PERMIT NUMBER
04*
* 20.00
* 20.00
419, 4z
05-26-82
6479.
1
1
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
$ 41 9,.5 g *20.00
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE DATE ISSUED PERMIT NO. TOTAL