1979, 10-24 Permit: 79-6607 Wood StovePLAN NUMBER
APPLICAT4OR/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
/ S'D// c
5 BDIVISION
LEGAL DESCRIPTION — SEE ATTACHED
3
4.
5.
OWNER
ADDRESS
CONTRACTOR
ADDRESS
DESIGNER
PHONE
y2 - Auk
PHONE
ZIP
PHONE
ADDRESS
ZIP
PARCEL NUMBER/5
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.
OWL Area Basement Area Garage Area Storage
CHANGE OF USE FROM
6.
TYPE
7. OF
WORK
TO
Split Entry
Split Level
Rancher
❑ NEW
❑ BLD.
O ALT. 0 AD N. 0 RPL. 0 MVE.
O PLMB. MECH: 0 M.H. 0 POOL
0 OTHER
No. Baths
No. Floors
No. Rooms
Rec. Room
CERTIFICATE
of EXEMPTION
Req'd.
Recd.
Not Req'd.
8.
9.
DESCRIBE WORK
VALUATION
•
Source
of
Utilities
GAS
ELECTRIC
WATER
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. RECD.
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Zone Clearance
SEPA Checklist
SPECIAL CONDITIONS:
DATER OFFIC
APPRFOR ISSUANCE
FEES COLLECTED
Single $
Building
Plumbing,
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL $
ti-^
DATE C(/ A onC 04* /7o O%
*7.00 En
*7.006
E *Q00 8
6.6Q62
10-24-7,9
2 6479.
PERMIT NUMBER
77 - &Gd 7
r')
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS B COM A PERMIT.
1.11'.-t2 4/ .719 6!6'0.7Z *ZOO?. le
e