1980, 09-03 Permit: 80-9499 Wood StovePLAN NUMBER
lJ
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
JOB ADDRESS
LOT BLOCK SUB gyISION
LEGAL DESCRIPTION — SEE ATTACHED
2.
OWNER et
3. ;(`1.anti 4. a.
ADDRESSJ t /J ^ / n
CONTRACTOR
4.
5.
PARCEL NUMBER/S
PHONE
ZIP
1717/S7
Actual Set Backs in Feet II
North . 'South 1East 'West
PHONE
Size of Parcel 1 Zone Classification
ADDRESS
«! 0 -' 4 e.—
DESIGNER
ZIP
Type Const.
Occupancy
Sprinklered
Dues ONo 0 Req'd.
PHONE
Valuation lBuilding Area in Sq. Ft.
ADDRESS
CHANGE OF USE FROM
6.
TYPE
7. OF
WORK
ZIP
Main Floor
Upper Floors Garage Area
Storage
TO
Area of Decks
Finished Basement
Untln. Basement
❑ NEW
O BLD.
O ALT.
O PLMB.
0 AD N.
MECH.
❑ RPL.
❑ M.H.
O MVE.
O POOL
0 OTHER
No. Baths
No. Stories
No. Rooms
No. of Dwellings
CERTIFICATE
of EXEMPTION
Req'd.
Recd.
Not Req'd.
DESCRIBE W RK
VALUATION
9.
SOURCE
OF
UTILITIES
5
H541��u�c�1 yr c. tite—tAt
ELECTRIC
WATE
SEWER
Enum. Dist.
Location (Area)
Ownership
Public 0 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 •
DATE OF APPLICATION q--.3 I SIGNATURE OF APPLICANT±
SPECIAL APPROVALS SPECIAL CONDITIONS:
NAME DATE
Env. Health
Planning
Fire Marshall
Co
Enginee
Utilities
Plans Examiner
SEPA Checklist
Bu i ding Technician?
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
FEES COLLECTED
Single $
Building
Plumbing
'fes
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL
PERMIT NUMBER
04* *7.00
'*7.00 N
949.82
09-02`-80
2 6479.
r
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT. •
,Oi5r"IO3`•$I Uj
DATE ISSUED
9 4 9.95 47.0 0 a: -
PERMIT NO. TOTAL