1979, 11-02 Permit: 79-7196 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
1. ly�,05 fJJT- /(/G%lJy, S'0/T1{7ViF1 1.11 /1 -SX,
LOT BLOCK SUBDIVISION
2.
LEGAL DESCRIPTION - SEE ATTACHED
OWNER
t
3 L f ;lir?? it A-PYIA
ADDRESS L
/ 4/ 6 /A -IA -2d y<r6A., rviir. icni
CONTRACTOR
4.
PHONE
9.911 4''o<%
ZIP
cit
PARCEL NUMBER/S
PHONE
ADDRESS
ZIP
DESIGNER
5. ADDRESS
PHONE
ZIP
Required Set Backs in Feet
North 'South East (West
Size of Parcel - - Zone Classification
Type Const. Occupancy Sprinklered
❑Ves ❑No 0 Req'd.
Valuation Building Area in Sq. Ft.
DWL Area I Basement Area ( Garage Area . Storage
CHANGE OF USE FROM
6.
TYPE
7. OF
WORK
TO
Split Entry
Split Level
Rancher
❑ NEW
❑ BLD.
❑ ALT. 0 AD N. ❑ RPL. 0 MVE.
O PLMB. OL MECH: ❑ M.H. 0 POOL
0 OTHER
No. Baths
No. Floors
No. Rooms
Rec. Room
CERTIFICATE
of EXEMPTION
Req'd.
Rec'd.
Not Req'd.
8.
9.
DESCRIBE WORK
VALUATION
Source GAS ELECTRIC
of
Utilities
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 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. RECD.
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Zone Clearance
SEPA Checklist
SPECIAL CONDITIONS:
DATE OFFICIAL
APPROVED FOR ISSUANCE
FEES COLLECTED•
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Horne
Other (Specify)
TOTAL
$ 7100
PERMIT NUMBER
DATE
04*
*7.00
*7.00 n
71 9.52
11-02-79
2 6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
II2-1cI
1[5.0'