1980, 03-24 Permit: 80-2579 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 4 COPIES
1.
2.
3.
4.
JOB ADDRESS
LOT
BLOC
//a 3 77.
K SUBDIVISION
LEGAL DESCRIPTION - SEE ATTACHED
OWNER
ADDRESS
CONTRACTOR
PHONE
9a�-9a3s�
PARCEL NUMBER/S
ZIP
99,2a‘,
PHONE
ADDRESS
ZIP
5.
DESIGNER
PHONE
ADDRESS
ZIP
Required Set Backs in Feet
North 'South East (West
Size of Parcel - Zone Classification
Type Const. Occupancy Sprinklered
❑Ves DNo 0 Req'd.
Valuation Building Area In Sq. Ft.
DWL Area I Basement Area ( Garage Area Storage
CHANGE OF USE FROM
6.
TO
Spilt Entry
Split Level
Rancher
TYPE 0 NEW
7. OF
WORK 0 BLD.
❑ ALT.
❑ PLMB.
❑ AD N.
❑ MECH:
❑ RPL.
❑ M.H.
❑ MVE.
❑ POOL
0 OTHER
No. Baths
No. Floors
No. Rooms
Rec. Room
CERTIFICATE
of EXEMPTION
Req'd.
Recd.
Not Req'd.
DESCRIBE WORK
8.
/2
VALUATION
B.
Source
of
Utilities
GAS
ELECTRIC
WATER
SEWER
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.
DATE - SIGNATURE
DEPT.
SPECIAL APPROVALS
REQ'D. REC'D.
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Zone Clearance
SEPA Checklist
SPECIAL CONDITIONS:
DATE 3 -au OFFICIAL` i \I�.JVLvVUC�Y�
APPROVED FOR ISSUANCE
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL $ ��
PERMIT NUMBER
M-cao-asriq
DATE . J7 a/ /sgo
04* *7.00
*7.00
*7.008
E *000
257.88
03-24-80
2 6479. -
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS O'5.r-21 EzS'A ,E,jiMIT.
2 Cil 9
Z