1981, 05-15 Permit: 81A-4760 WoodstovePLAN NUMBER
APPLICATION/ PERMIT
SPOKANE COUNTY — BUILDING CODES DEPARTMENT
/ NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675 DATE
k-/ APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 4 COPIES
JOB ZDRESS
D LEGAL DESCRIPTION — SEE ATTACHED
1.LOT I BLOCK ISUBDIVISION PARCEL NUMBER/S
2.
OWNER PHONE
3. Aj/r rOWAJ
iA DRESS ZIP Required Set Backs in Feet
North South East West
CONT R TOR PHONE Size of Parcel Zone Classification
qvo N Z- jC `P rks
4.
FEES COLLECTED
8. N S 0!%c. o�'C-J� r r t a cQ d o
ADDI /E���S
�f
/,r
/J
GAS
ZIP s�
7/"14,
.
Type Constccupancy
O
Sprinklered
❑Yes ❑No ElReq'd.
DESIGNER
Jf
PHONE
Valuation
Building Area in Sq. Ft.
5.
1 hereby certify that I have read and examined this application and have read the "NOTICE" provisions included
ADDRESS
ZIP
DWL Area
Basement Area
Garage Area
Storage
to give authority to violate or cancel the provisions of any other state or o I law regulating construction or the
CHANGE OF USE FROM
TO
Plumbing
Split Entry
Split Level
Rancher
6.
1%
DATE of
Mech.
SPECIAL APPROVALS SPECIAt CONDITIONS:
TYPE
No. Baths
No. Floors
No. Rooms
Rec. Room
NEW
❑ ALT. ❑ N. 1:1 RPL.
ElMVE.
SEPA
%, OF
Planning
❑OTHER
Fire Marshall
Mobile Home
1:1 BLD.
❑ PLMB. ����"""" MECH: ❑ M. H.
El POOL
CERTIFICATE
Req'd.
Recd.
Not Req'd.
WORK
of EXEMPTION
TOTAL $
DESCRIBE OR�y I
"-c
FEES COLLECTED
8. N S 0!%c. o�'C-J� r r t a cQ d o
VALUATION
Source
GAS
ELECTRIC
WATER
SEWER
9.
of
Utilities
Single $
1 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
Building
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 o I law regulating construction or the
performance of construction.
Plumbing
•
" /0 " SIGNATURE
1%
DATE of
Mech.
SPECIAL APPROVALS SPECIAt CONDITIONS:
DEPT. RECQ'D. RECD.
Plan Check
Env. Health
SEPA
Planning
Fire Marshall
Mobile Home
Co. Engineer
Other (Specify)
Utilities
TOTAL $
Zone Clearance
WHEN MACHINE VALIDATED
I
SEPA Checklist
THIS RE,0
DATE OFFICIAL
PERMIT NUMBER
9,,A -4-7.O
i SPACE,
47602 *17.0,0a-�J-