1979, 12-21 Permit: 79-9389 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
LOT
2.
BLOCK ,SUBDIVISION 1\_y -c)_•
LEGAL DESCRIPTION — SEE ATTACHED
OW NE �•y .^/
3. ADDR C. .1s..� u C
CONTR' T R
4' ADDR
PHONE
Qa6, - VoSa
ZIP
PARCEL NUMBER/S
Required Set Backs in Feet
North 'South East IWest
_
DESIGNER
5' ADDRESS
�•�c33
PHONE
°CIS 91-S44
ZIP
4'g ao r7
Size of Parcel - 1 Zone Classification
Type Const.
Occupancy
Sprinklered
❑Yes ❑No ❑ Req'd.
PHONE
Valuation I Building Area in Sq. Ft.
ZIP
OWL Area I Basement Area Garage Area
•
Storage
CHANGE OF USE FROM
6.
TO
Split Entry
Split Level
Rancher
TYPE
7. OF
WORK
NEW 0 ALT.
OEtBLD. ❑ PLMB.
❑ AD N.
O MECH
❑ RPL.
❑ M.H.
❑ MVE.
O POOL
0 OTHER
No. Baths
No. Floors
No. Rooms
Rec. Room
CERTIFICATE
of EXEMPTION
Req'd.
Recd.
Not Req'd.
8.
9.
DESCRIBE,WORK
rI l 0-0TO X
VALUATION
Source
of
Utilities
GAS
' .I
WATER
ECTRIC I
SEWER
I hereby certify that I have read and examined this applica ion 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:
DATEI3Ja/[ icl OFFICIAL
II APPROVED FOR ISSUANCE _
-rt40M M,C711
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL $
DATE
PERMIT NUMBER
04* *7.00
*7.00 tz
*7.000
E *Q00
93882 -
12-21=79
a 6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THISRBn? AIRVMIT.
9'38,92 A7,0.0°LP