1981, 03-05 Permit: M81A-2067 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
r). 12010 Buckeye
LEGAL DESCRIPTION — SEE ATTACHED
LOT
BLOCK
SUBDIVISION
3.
OWNER
Sar,' Lane
ADDRESS
r;. 12010 Buckeye
CONTRACTOR
4' ADDRESS
Valley Fireplace, Inc.
PHONE
928-1381
ZIP
PARCEL NUMBER/S
E. 16610 Sprague Ave.
DESIGNER
ADDRESS
Veradale, WA
No. VA LL EF 626 0I
CHANGE OF USE FROM
6.
TYPE
7. OF
WORK
❑ NEW
❑ BLD.
❑ ALT.
❑ PLMB.
PHONE
ZIP
TO
❑ AD'N.
❑ MECH:
❑ RPL.
❑ M.H.
O MVE.
O POOL
IIIOTHER
DESCRIBE WORK Install "Blaze King" KTJ, Top, Jet Air Wood Stove
Required Set Backs in Feet
North South East West
Size of Parcel
Type Const.
Occupancy
Zone Classification
Sprinklered
❑Yes ❑No ❑ Req'd.
Valuation
DWL Area
Basement Area
Split Entry
No. Baths
Building Area in Sq. Ft.
Garage Area
Split Level
No. Floors
CERTIFICATE
of EXEMPTION
VALUATION
9.
Source
of
Utilities
GAS
ELECTRIC
WATER
Storage
Rancher
No. Rooms
Rec. Room
Req'd. Rec'd.
Not 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 loclaw regulating constryeion or the
performance of constron.
sy
/..
DATE
DEPT.
SPECIAL APPROVALS
REQ'D. REC'D.
SIGNATURE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Zone Clearance
SEPA Checklist
SPECIAL CONDITIONS:
Ready for inspection.
b�
DATE`"'/5 [Jr OFF IAL
APPROVED FOR ISSUANCE
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL $ / 7r
n
DATE 3/4081
PERMIT NUMBER
gM
0 4 *
* 17.00
* 1700
* 17.008
A *0.00
20662
03-05-81
6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
0'3+; 6,5,-81 2067 *T%00a�