1980, 12-29 Permit: 80B-5267 Wood Stove(PLAN NUMBER
e/
APPLICATION/PERMIT
SPOKANE COUNTY — BUILDING CODES DEPARTMENT
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 4563675
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
t.
2.
JOOB ADDRESST L (40 CE< SUBDIVISI6N �VI
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LEGAL DESCRIPTION — SEE ATTACHED
4.
NER
owtolvl &" f5ARNJ 6e-7
ADDRE11 C° G • r41 V �V
CONTRAT
PHONE �y
ZIP
a99)
PHONE ✓
PARCEL NUMBER/5
Actual Set Backs in Feet I
North 'South East (West
Size of Parcel - I Zone Classification
ADDRESS
ZIP
Type Const.
Occupancy
Sprinklered
Dyes ONo D Req'd.
5.
DESIGNER
PHONE
Valuation I Building Area in Sq. Ft.
ADDRESS
ZIP
Main Floor
Upper Floors 1 Garage Area
Storage
6.
TYPE
7. OF
WORK
CHANGE OF US! FROM
TO
Area of Decks
Finished Basement
Unf in. Basement
EW
0 ALT. 0 AD N. 0 RPL. 0 MVE. •
/
0 OTHER
❑ BLD. -0 PLMB. Ll'1 MECH. 0 M.H. 0 POOL
No. Baths
No. Stories
No. Rooms
No. of Dwellings
CERTIFICATE
of EXEMPTION
Req'd.
Recd.
Not Req'd.
8 DESCR,B^�ORK `J'11A1 6
Enum. Dist.
Location (Area)
VALUATION
9.
SOURCE
OF
UTILITIES
GAS
ELECTRIC
WATER
SEWER
Ownership
Public D Private 0
USE CODE
I hereby certify that 1 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`" atSIGNATURE OF APPLICANakn
SPECIAL APPROVALS
NAME DATE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
SPE IAL 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)
2100
-7, 00
TOTAL $
PERMIT NUMBER
5-2G7
04* *7.00
*7.00
*7.00,5
A *000 8
5268
12-29-8.0
2 6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
2 2 9.!,8101 5,2191 *1,0,0
DATE ISSUED PERMIT NO. TOTAL
>-
0-
0
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