1979, 10-22 Permit: 79-6468 Wood StovePLAN NUMBER
APPLICAYIOItl/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
1.
2.
3.
4.
JOB ADDRESS_
r j59 4- C
LOT
BLOCK UBDIV SION
LEGAL DESCRIPTION - SEE ATTACHED
PARCEL NUMBER/S
OWNER 1 1 c2 I[J✓
ADDF. 7 2q-
CONTRA O 6-
P ONE
6,30
ZIP
Required Set Backs in Feet
North 'South East 'West
PHONE
Size of Parcel 1 Zone Classification
'ADDRESS
ZIP
_ Type Const.
Occupancy
-Sprinklered
❑Yes ❑No ❑ Req'd.
5.
DESIGNER •
PHONE
Valuation I Building Area in Sq. Ft.
ADDRESS
ZIP
DWL Area I Basement Area
Garage Area
Storage
CHANGE OF USE FROM
6.
TYPE
7. OF
WORK
TO
(rJ' NEW
Split Entry
Split Level
Rancher
0 ALT. 0AD N. 0 RPL. 0 MVE.
❑ BLD. ❑ PLMB. E /MECH: 0 M.H. 0 POOL
0 OTHER
' No. Baths
No. Floors
No. Rooms
Rec. Room
•CERTIFICATE
of EXEMPTION
Req'd. .
Rec'd.-
Not Req'd.
DESCRIBE NOO WORK 1/IJ 'VII `rol IV `/
J ✓
$ VALUATION Source GAS
of
9. Utilities
ELECTRIC
WATER
SEWER
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.
DATE
SIGNATURE
DEPT.
'SPECIAL APPROVALS
REQ'D. RECD.
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Zone Clearance
SEPA Checklist
SPECIAL CONDITIONS:
DATE /O2
APP 'T FOR ISSUANCE
FEES COLLECTED
Single
Building
Plumbing
7 p0
Mech.
Plan Check
SEPA
Mobile Home
•
Other (Specify)
TOTAL $
•
M
PERMIT NUMBER
—�U
DATE
04* *7.00
*7.00 t5
*7.006
E *000
6467A
10-22-79
@ 647.9.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS IjE,FOnuf RM IT. ,
6'4'6'82 '*7.0.0.2g