1980, 09-04 Permit: 80-9649 Wood StovePLAN NUMBER
07
APPLICATIO M[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. s. Z,3/3 /i6/2,qG
LOT BLOCK
2.
SUBDIVISION
LEGAL DESCRIPTION - SEE ATTACHED
PARCEL NUMBER/5
OWNER
3. 6o. Seep CE
ADDRESS
5. aa t EQAL O
PHONE
4Z6 -7U28
ZIP
Actual Set Backs in Feet
North 'South [East 'West
CONTRACTOR
4 s�JmE
ADDRESS
agmE
PHONE
Size of Parcel 1 Zone Classification
ZIP
Type Const.
Occupancy
Sprinklered
❑Yes ❑No 0 Req'd.
5.
DESIGNER
PHONE
Valuation 1 Building 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
Unf in. Basement
TYPE
7. OF
WORK
NEW 0 ALT. DJD N. 0 RPL. 0 MVE.
M
0 BLD. ❑ PLB. L7 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. rPr•'C 00 3'J/a/1en4 s7Q t/E
VALUATIONSOURCE
OF
9. UTILITIES
Enum. Dist. I Location (Area)
GAS ELECTRIC
WATER
SEWER
Ownership
Public ❑ Private 0
USE CODE
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. SEE REVERSE SIDE FOR REQUIRED INSPECTIONS
q/i//�,,�
DATE OF APPLICATION gO SIGNATURE OF APPLICANT�C2��f�
SPECIAL APPROVALS SPECIAL CONDITIONS:
NAME DATE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilitie
Plans Examiner
SEPA Checkli
Bu i Id ng Technician
PERMIT IS NONTRANSFERABLE,
FEES COLLECTED
Single $
Building
Plumbing
ech. •
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL $ (J- c
PERMIT NR
SOr %CA
04* *7.00
*7.00 N
964.82
09-04-80
2 6479.
}
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE DATE ISSUED
9 6 4 9'6 * 7'0 0, ° -
PERMIT NO. TOTAL