1980, 10-30 Permit: 80B-2978 WoodstovePLAN 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 '
JOB ADDRESS
1. e 18,16
LOBLOCK
OW ER
2.
3. L-vLa4
ADDRESS
CChNTRACTOR
/ivii'iikile, 1.0.111
SUBDIVISION
li-
LEGAL DESCRIPTION - SEE ATTACHED
PHONE '
PARCEL NUMBER/S
5.
DRESS
DESIGNER
ZIP'
q9. eUr;:
• Actual Set Backs in Feet
North (South East
(West
PHONE
ZIP
PHONE
Size of Parcel
Type Const.
Valuation
Occupancy
Zone Classification
Sprinklered
❑Yes ❑No 0 Req'd.
Building Area in Sq..Ft.
ADDRESS
ZIP
Main. Floor
Upper Floors
Garage Area
• Storage
CHANGE OF USE FROM
6.
TO
Area of Decks
Finished Basement
Unfin. Basement
TYPE
7. OF
WORK
❑ NEW
❑ BLD.
❑ ALT.
❑ PLMB.ISQ
❑ AD N.
MECH.
❑ RPL.
❑•M.H.
❑ MVE.
O POOL
0 OTHER
No. Baths
No. Stories
No. Rooms
No. of Dwellings
CERTIFICATE
of EXEMPTION
Req'd.
Rec'd.
Not Req'd.
ESCRIBE
8.
VALUATION
Enum. Dist.
Location (Area)
SOURCE
OF
UTILITIES
`GAS '
ELECTRIC
.WAT R
SEWER
Ownership
Public ❑ Private 0
USE CODE
9.
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 /O'er 341-g4) SIGNATURE OF APPLICANT
SPECIAL APPROVALS .
NAME -DATE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
Bu' ing Tec icia/q'vt/ eLi
SPECIAL CONDITIONS:.
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE DATE ISSUED
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
,7
TOTAL
$ f
PERMIT NUMBER
Sid .0 --29 7g
0 4-*
.700 N •
297.72
2 6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
l°or3a 801
2 977;`8 • 7.0'0;1;-;
PERMIT NO. TOTAL