1979, 12-06 Permit: 79-8786 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
— JOB ADDRESS 2�
1. LC / 9d
LOT BL CK SUBDI 61ON n Cad -
PHONE
, /
2. 7 1/ A4%CW4: /.(/ ,I�,IX iY Jci C,Cf-d-
PHONE
OWNER
3 gyo-C,/.oAti 114,ay
DDRESS
CC:* //96i/ .ce_
CO[JTRACTOR
.Q/b1,a-
AD RESS
i
DESIGNERGNER
4.
5.
LEGAL DESCRIPTION - SEE ATTACHED
PARCEL NUMBER/S
ZIP
99.261,
Required Set Backs in Feet
North (South East 'West
PHONE
Size of Parcel
Zone Classification
ZIP
• Type Const.
Occupancy Sprinklered
❑Yes ❑No 0 Req'd.
PHONE
Valuation
Building Area in Sq. Ft.
ADDRESS
ZIP
DWL Area I Basement Area
Garage Area
Storage
CHANGE OF USE FROM
6.
TYPENEW
❑ ❑ AL
7. OF
WORK BLD. 0PLM B.
TO
Split Entry
Split Level
Rancher
❑ AD N.
MECH:
❑ RPL.
❑ M.H.
❑ MVE.
O POOL
0 OTHER
No. Baths
No. Floors
No. Rooms
Rec. Room
CERTIFICATE
of EXEMPTION
Req'd.
Re 'd.
Not Req'd.
DESCRIBE
�WORK
8. v,' K Ott t.'Y.2.(t-d-Lu
VALUATION CV] Source GAS ELECTRIC
of
9. Utilities
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.
SIGNATURE �. I '1 At ♦-.. a ^.
WATER
SEWER
DATE /a2-6 -7
DEPT_
SPECIALAPPROVALS
REO'O. RECD.
Env. Health
Planning
Fire Marshall
•
Co. Engineer
Utilities
Zone Clearance
SEPA Checklist
SPECIAL CONDITIONS:
/2-6- 79
DATE OFFICIA
1, 'y
APPROVED FOR ISSUANCE
FEES COLLECTED
Single $
Building
Plumbing
7�0
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL 17'
oU
. I
PERMIT NUMBER
79- ff73%
DATE /20-7%
*7.0 0
878.5B
12=06'=7i9
f 6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
12.'-:0'6°-;7i9' 8/8.6 z A7.0,0 a e