1980, 10-01 Permit: 80B-1256 Wood StovePLAN NUMBER
V
1
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. 5'. 29/6. Fax Re.
LOT BLOCK
2.
SUBDIVISION
LEGAL DESCRIPTION — SEE ATTACHED
3
OWNER
/'CE/TH - P7' ...ene.d/t/
PHONE '
9z8-aayvc
PARCEL NUMBER/S
ADDRESS
5. a9/B Fox P0.
ZIP
99zoc
Actual Set Backs in Feet
North • 'South East 'West
4.
CONTRACTOR
ADDRESS
SI/21C
PHONE
Size of Parcel 1 Zone Classification
ZIP
Type Const:
Occupancy
Sprinklered
❑Yes ❑No ❑ Req'd.
5.
DESIGNER
PHONE
Valuation 1Building Area In Sq. Ft.
ADDRESS
ZIP
Main Floor
Upper Floors 1 Garage Area
Storage
CHANGE OF USE FROM
6.
TO
Area of Decks
Finished Basement
Unfin. Basement
TYPE
7. OF
WORK
CJ NEW 0 ALT. 0 AD N. 0 RPL. ❑ MVE.
0 BLD. 0 PLMB. . 'MECH. 0 M.H. 0 POOL
0 OTHER
No. Baths
No. Stories
No. Rooms
No. of Dwellings
CERTIFICATE
of EXEMPTION
Req'd.
Recd.
Not Req'd.
DESCRIBE WORK
8. &tt 0EtteS I, ?J/ivG Srod6
Enum. Dist.
Location (Area)
VALUATION
9.
SOURCE
OF
UTILITIES
GAS
ELECTRIC
WATER
SEWER
Ownership
Public 0 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 / Gk 86 SIGNATURE OF APPLICANT
SPECIAL APPROVALS
NAME DATE
Env. Health
arming
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
Bu Iden Technician
SPECIAL CONDITIONS:
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
FEES COLLECTED
Single $
Building
Plumbing ...,
Mech. " j�jja1-00
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL $7-rn
PERMIT NUMBER
Boa- 12sCA
04* *7.00
*700 16
*7.006 .
A *0.00 S
12554
1.0=01'-80
6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT. •
112.5, 6"5 'A 710 0 —
DATE ISSUED PERMIT NO. TOTAL