1980, 12-22 Permit: 80B-5135 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
JOB ADDRESS
(I ) Flocs r.1 LJ i v' c 1., (TR cA ,
LOT BLOCK . SUBDIVISION
2.
OWGN EER
0�',� `
ADDRE55LA CR0 i L i (t /k YAN1�
klc(5S N 1zA ,
CONTRACTOR�.
c'
4.
PHONE
LEGAL DESCRIPTION — SEE ATTACHED
PARCEL NUF BER/t
ZIP
Actual Set Backs in Feet
North IS
PHONE •
Size of Parcel
•
ADDRESS
SAME
DESIGNER
5.
ADDRESS
ZIP
Type Const.
PHONE
Valuation
ZIP
Main Floor
ouch - East (West
Occupancy Sprinklered
❑Yes ❑No 0 Req'd.
Floors Garage Area
Upper
Zone Classification
1.
Building Area in Sq. Ft.
Storage
CHANGE OF USE FROM
6.
TO
Area of Decks
Finished Basement
Unfin. Basement
TYPE
7. OF
WORK
I1NEW ❑ ALT. ❑. )D N. 0 RPL. ❑ MVE.
0 BLD. 0 PLMB. MECH. 0 M.H. 0 POOL
❑ OTHER
No. Baths
No. Stories
No. Rooms
No. of Dwellings
CERTIFICATE
of EXEMPTION '
Req'd.
Recd:
Not Req'd.
8.
DESCRIBERK
/A )0(
Enum. Dist.
Location (Area)
VALUATION
9.
SOURCE GAS
OF
UTILITIES
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 -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
..SATE OF APPLICATION / 2 ? 'P /SIGNATURE OF APPLICANT
SPECIAL APPROVALS
NAME DATE
Env. Health
Planning
Fire Marshall
Co. Engineer
• Utilities
Plans Examiner
SEPA Checklist
9iltlin Technician
SPECIAL CONDITIONS:
1
r, ' 1O -- Q.,: .
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
FEES COLLECTED
Single $
Building -
Plumbing
0
Mech.
Plan Check
SEPA
Mobile Home-
Other
omeOther (Specify)
TOTAL $
pi
NUMBER
63613'rJ I �?
04* *7.00
*7.00 ti
*7.006
A *0.00
51'3.42
12=22-80
2. 6479,
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
5111 `5'Z *7,00.28
DATE ISSUED - PERMIT NO. TOTAL
0
0
U
J
LL