1979, 12-12 Permit: 79-9012 WoodstovePLAN 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 LEGAL DESCRIPTION — SEE ATTACHED
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L(QI BLOCK JbUBDIT1510M PARCEL NUMBER/S
10
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TRACTOR
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IGNER
5. ADDRESS
CHANGE OF USE FROM ITO
6.
PPHO'NE,
ZIP
PHONE
ZIP
PHONE
ZIP
I rrt ❑ NEW ❑ ALT. ❑ AD'N. ❑ RPL. ❑ MVE.
% OF 1:1 OTHER
WORK 1:1BLD. ❑ PLMB. K MECH: ❑ M.H. ❑ POOL
D SCRIBE WORK
8. ya -
f
Required Set Backs in Feet
North South East West
Size of Parcel
Zone Classification
Type Const. I
Occupancy
Sprinklered
❑Yes ❑No ❑ Req'd.
Valuation
Building Area in Sq. Ft.
DWL Area
Basement Area
Garage Area
Storage
Split Entry
Split Level
Rancher
No. Baths
No. Floors
No. Rooms
I Rec. Room
CERTIFICATE
of EXEMPTION
Req'd.
Recd.
Not Req'd.
tf 1A"-1 FEES COLLECTED
PERMIT NUMBER
DATE Z-2—J;Z— 71
VALUATION
Source
U
ELECTRIC
WATER
SEWjthis
9.
of
Utilities
Single $
I hereby certify that I have read and examined this application and have read the "NOTICE" provisions
on reverse side, and know the same to be true and correct. All provisions of laws and ordinances goverBuilding
type of work will be complied with whether specified herein or not. The granting of a permit does notto
give authority to violateor cancel the provisions of any other state or local law regulating constructio
performance of con-s�truction.
Plumbing
)
DATE/;Z—/-Z— ! SIGNATURE
4/
Mech.
SPECIAL APPROVALS
SPECIAL CONDITIONS:
DEPT. REQ'D. RECD.
Plan Check
Env. Health
SEPA
Planning
Mobile Home
Fire Marshall
Other (Specify)
Co. Engineer
TOTAL $
Utilities
Zone Clearance
WHEN MACHINE VALIDATED IN THIS SPACE,
SEPA Checklist
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THIS BECOMES A PERMIT.
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DATE OFFICIAL�Lnn!!
ADDDMIM MD IccIIAKIPE
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