1981, 10-22 Permit: 81B-1003 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 D
1. a.i�z N Cftj l&
LOTDBLORESSoK SUED 'SIO
2.
owrv�R�sitS1-12piir
3 J
ADD 'ESS
LEGAL DESCRIPTION — SEE ATTACHED
4.
CONTRA TO ,
ADDRESS
NE
Ir3Oel
(ZZII PP 20
PHONE
PARCEL NUMBER/5
Actual Set Backs in Feet
North 'South East 'West
Size of Parcel Zone Classification
ZIP
Type Const.
Occupancy Sprinklered
❑Yes CNo 0 Req'd.
5.
DESIGNER
PHONE
Valuation
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
Unf in. Basement
FICIEW 0 ALT. ❑AD N. 0 RPL. ❑ MVE.
0 BLD. 0 PLMB. ff./MECH. 0 M.H. 0 POOL
0 OTHER
No. Baths
No. Stories
No. Rooms
No. of Dwellings
CERTIFICATE
of EXEMPTION
Req'd.
Recd.
Not Req'd.
8.
DESCR BE WORK
009 Si6s/G
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 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 • law regulati`•_nstruction or the
performance of construction. SEE REVERSE SIDE FOR REQUIRED INSPECT! NS
DATE OF APPLICATION
SPECIAL APPROVALS
NAME DATE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Check!
SIGNATURE OF APPLICANT
SPECIAL CONDITIONS:
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
FEES COLLECTED
Single $
Building
Plumbing
Mech. '7
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL $
-7
PERMIT NUMBER
113 - 1003
04* *17.00
*17.00
*17,00'6
A *000 8
10.028
10-22-81
g 6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
t;:1212 78;-1
DATE ISSUED
1'0b:3'5 *17.0'O:2.� -
PERMIT NO. TOTAL