1980, 10-28 Permit: 80B-2795 Wood StovePLAN NUMBER
coy
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 ADDRESS
1. F /07.Z Z /m9/9X)44-cc
LOT B OCK SUBDIVISION
2.
LEGAL DESCRIPTION — SEE ATTACHED
PARCEL NUMBER/S
OWNER
3; #511,/? V
ADDRESS
E. /o7zz
CONTRACTOR
4Snrn
,
ADDRESS
a5/9/2/Ci
DESIGNER
6' ADDRESS
•
f1,97,471/
/97iX17/EGr
PHONE
9'z6 -s877
ZIP
992/e
Actual Set Backs in Feet
North (South East 'West
PHONE
Size of Parcel 1 Zone Classification
ZIP
Type Const.
Occupancy
Sprinklered
DYes ONo 0 Req'd.
PHONE
Valuation I Building Area in Sq. Ft.
ZIP
Main Floor
Upper Floors 1 Garage Area
Storage
CHANGE OF USE FROM
6.
TO
Area of Decks
Finished Basement
Unfin. Basement
TYPE 0 NEW
7. OF
WORK 0 BLD.
0 ALT. 0/AD N. 0 RPL. 0 MVE,
❑ PLMB. til 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.
DESCRIBE WORK
8. L...202 JaURNiitJC;
VALUATION
9.
SOURCE
OF
UTILITIES
S'rduc
Enum. Dist. I Location (Area)
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 local law regulating construction or the
performance of construction. SEE REVERSE SIDE FOR REQUIRED INSPECTIONS
DATE OF APPLICATION
SIGNATURE OF APPLICANT
SPECIAL APPROVALS
NAME DATE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklis
Bu din• -chnician
sr
SPECIAL CONDITIONS:
• PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
FEES COLLECTED
Single $
Building
Plumbing'
Mech.
7. o2J
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL
$ 7.06
m
PERMIT NUMBER
80E- 'a -70(6e
04* *7.00
*7.00 to
279.42
10'=28-8o
2 6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
1o, 2:&`?8't'
DATE ISSUED
2`19.5-z
PERMIT NO.
•
a FJ-,
TOTAL