1980, 10-15 Permit: 80B-2056 Wood Stove/0/' W
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
J B ADDRESSpp
t. Lori �OBLOLK7
2.
ISSIIiiN
19-4 tut --74../ x9.1
LEGAL DESCRIPTION — SEE ATTACHED
4.
5.
O NER
A DRESS
CONT2 3R (°47 �/ N9//f9L/J
ter .4.4/14..1 --
PHONE
21-3J
ZIP
99,37
PARCEL NUMBER/S
Actual Set Backs In Feet
North 'South
East
'West
PHONE
Size of Parcel
Zone Classification
AD RESS
DESIGNER
ZIP
Type Const.
Occupancy - Sprinklered
IGYes ❑No 0 Req'd.
PHONE
Valuation
Building Area I Sq. Ft.
ADDRESS
ZIP
Main Floor
Upper Floors
Garage Area
Storage
CHANGE OF USE FROM
TO
Area of Decks
Finished Basement
Unfin. Basement
TYPE 0 NEW
7. OF
WORK BLD.
O ALT.
O PLMB.
❑ AD N. 0 RPL. 0 MVE.
0 OTHER
Jg MECH. 0 M.H. 0 POOL /
L644 ,u rrEmcc�t YY
B VALUATION
9. ,�:}'� O
pESVW/1,Li_.UG/�Gf.�i�C.�
SOURCE
OF
TILITIES
GAS
ELECTRIC
WATER
SEWER
No. Baths
No. Stories
No. Rooms
No. of Dwellings
CERTIFICATE
of EXEMPTION
Req'd.
Rec'd.
Not Req'd.
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 gran ' of a permit does not presume
to give authority to violate or cancel the provisions of any other state or local av regulating consugtithe
performance of construction. SEE REVERSE SIDE FOR REQUIRED INSPECTIOjt11
DATE OF APPLICATION J/1 --/C)---Fd - SIGNATURE OF APPLICANT
SPECIAL APPROVALS
' NAME DATE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
Ting ech ivan�
(d 4IA 242
SPECIAL CONDITIONS:
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
FEES COLLECTED
Single
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Horne
Other (Specify)
1 6 -
d 0
TOTAL
M
PERMIT NUMBER
g05-
02*
as-
02* *1000
* 1000 17)
* 10.0,08
A *000 3
20542
10-15-8,0
2 6479. '
04* *7.0,0
*7.00 re -
*7.0.0(1
A *000
20552
10-15-8,0
2 6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
li.10' ;t1:51c181 '
DATE ISSUED
20.5.6 *17,0.0.
PERMIT NO. TOTAL
›-
0-
U-