1981, 02-11 Permit: 81A-1410 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 3 -COPIES
1.
2.
3.
JOB ADDRESS
LOT
S. 40E
1
■B. . ..
Dui(
901 5 % KDEILEed
AD RESS
Z4o(o NbwL
PHONE
'tZ4 -e5 13
LEGAL DESCRIPTION - SEE ATTACHED
PARCEL NU ICER/S r
ZII P�
�tZt(o
Actual Set Backs in Feet
North , 'South East (West
4.
CONTRACTOR
PHONE
Size of Parcel 1 Zone Classification
ADDRESS
ZIP
Type Const.
Occupancy
Sprinklered
❑Yes ❑No 0 Req'd.
5.
DESIGNER
PHONE
Valuation I Building Area in Sq. Ft.
ADDRESS
•
ZIP
Main Floor
Upper Floors Garage Area
Storage
CHANGE OF USE FROM
6.
TYPE
7. OF
WORK
TO
Area of Decks
Finished Basement
Unfin. Basement
LJ NEW
0 BLD.
❑ ALT.
❑ PLMB.
0 AD N.
MECH
❑ RPL.
❑ M.H.
❑ MVE.
❑ POOL
0 OTHER
No. Baths
No. Stories
No. Rooms
No. of Dwellings
CERTIFICATE
of EXEMPTION
Req'd.
Rec'd.
Not Req'd.
DESCRIBE WORK
8. 1UCZ7tYP,U21\ft11vCt '5T006_,
Enum. Dist.
Location (Area)
VALUATION
9.
SOURCE
OF
UTILITIES
GAS
ELECTRIC
WATER
SEWER
Ownership .
Public 0 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 ord'nances governing this
type of work will be complied with whether specified herein or not. The grant f�Q of a permit does not presume
to give authority to violate or cancel the provisions of any other state or local regulatjgg construction or the
performance of construction. SEE REVERSE SIDE FOR REQUIRED INSPECTIOND�
DATE OF APPLICATION //1. NV
� SIGNATURE OF APPLICANTLL �Y/!- /I telt.(!`
J 111
SPECIAL APPROVALS SPECIAL CONDITIONS:
NAME DATE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
Building oTechnician
PERMIT IS NONTRANSFERABLE
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL
fl—
$ 17-®0
/
PERMIT NUMBER
04* *1700
*17.0D
14092
02.-11-81
z 6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
.l
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE DATE ISSUED
140 *17.00T
He
PERMIT NO. TOTAL