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1980, 01-15 Permit: 80-0166 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 JOB ADDRESS •IIO U f LEGAL DESCRIPTION - SEE ATTACHED LOT BLOCK SUBDIVISION OWNkk4 VFF TGJYIIl-wiW ADXRSI I c'"'IIrnC111/014.0 PHONE 92&-2'Ol PARCEL NUMBER/5 Required Set Backs in Feet North 'South East 'West 4. CONT ADDRESS PHONE Size of Parcel 1 Zone Classification • ZIP , Type Const. Occupancy Sprinklered ❑Yes ❑No ❑ Req'd. 5. DESIGNER PHONE Valuation Building Area i Sq. Ft. ADDRESS ZIP DWL Area I Basement Area Garage Area Storage CHANGE OF USE FROM 6. TYPE 7. OF WORK TO Split Entry Split Level Rancher 0 ALT. �❑/AD N. 0 RPL. ❑ MVE. ❑ BLD. 0 PLMB. LTJ MECH: ❑ M.H. 0 POOL 0 OTHER No. Baths No. Floors No. Rooms Rec. Room CERTIFICATE of EXEMPTION Req'd. - Re 'd. Not Req'd. DESCI BE WORK 8. it l`IrYlC7F/1✓/r. VALUATION 9. 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 giv• authority to violate or cancel the provisions of any other state or local law regulating construction or the perf.: nce of construction. / / • DATE • 1� /' 8o SIGNATURE DEPT. SPECIAL APPROVALS REQ'D. RECD. Env. Health Planning Fire Marshall Co. Engineer Utilities Zone Clearance SEPA Checklist SPECIAL CONDITIONS: DATE 144111111 OF A .110101 FOR ISSUANCE FEES COLLECTED Single $ Building Plumbing 00 Mech. Plan Check SEPA Mobile Home Other (Specify) 7, 0 0 TOTAL $ M PERMIT NUMBER to - ©«ce:7 DATE 04* *7.00 *7.00 V) *7.0025 *Q00 S 165E 01-15-80 2 6479, WHEN MACHINE VALIDATED IN THIS SPACE, THIST,19L9IF,S Pt,R EORIMIT. 16.6'Z * I..0;01 CC O 0 U L▪ LJ0- rn