1981, 09-10 Permit: 81A-9147 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 ArlDRESS
�1I0 EL
LEGAL DESCRIPTION - SEE ATTACHED
LOT
BLOCK
SUBDIVISION
OWNER13
ADDIES5� I I
P
�-;HONE
-2i57
ZIP 6
PARCEL NUMBER/S
Actual Set Backs in Feet
North (South 'East 'West
4.
CONTRACTOR
PHONE
Size of Parcel 1 Zone Classification
ADDRESS
ZIP
Type Const.
Occupancy
Sprinklered
Elves ❑ No ❑ Req'd.
DESIGNER
5' ADDRESS
PHONE
Valuation (Building Area in Sq. Ft.
ZIP
Main Floor
Upper Floors 1 Garage Area
Storage
CHANGE OF USE FROM
6.
TYPE
7. OF
WORK
TO
Area of Decks
Finished Basement
Unfin. Basement
12 NEW ❑ ALT. ❑ ABN. ❑ RPL. ❑ MVE.
0 BLD. ❑ PLMB.MECH. 0 M.H. 0 POOL
❑ OTHER
No. Baths
No. Stories
No. Rooms
No. of Dwellings
CERTIFICATE
of EXEMPTION
Req'd.
Rec'd.
Not Req'd.
DESCRIBE WORK
Enum. Dist. I Location (Area)
VALUATION
9.
SOURCE
OF
UTILITIES
GAS
ELECTRIC
WATER
SEWER
Ownership
Public ❑ Private ❑
USE CODE
I hereby certify that I have read and examined this application and have read the "NOTICE" provisions included
on reverse side, aril] know the same to be true and correct. All provisions of laws and ordinances governing this
tyi'f 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
/DATE OF APPLICATIC
•_!� • SIGNATURE OF APPLICANT.�1L���LAf-
SPECIAL APPROVALS
NAME DATE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
nnician
SPECIAL CONDITIONS:
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL
17.
$ r'.
M
PERMIT NUMBER
3t/k'714-7
04* *17.00
*17.00 V)
* 1 7,006
A *000 ES
914.6g
09-10-81
z 6479
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATE ISSUED
PERMITD .4 7 z
*1 /,000 1--1