1979, 12-03 Permit: 79-8622 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 4 COPIES
1.
2.
3
JOB ADDRESS
'S//
T� BLOCK
GWNE8
7/Pri he, Rittre-s-ru
ADDRESS r1d4 ,�A4itt.
CONTRACTOR
44, .1
RESS
DESIGNER
n A9
LEGAL DESCRIPTION - SEE ATTACHED
SUBb!VISION
PARCEL NUMBER/S
5.
PHONE
g ;.kr-9'1/2
ZIP
99.2/6;
Required Set Backs in Feet
North 'South East 'West
PHONE
ZIP
PHONE
•
Size of Parcel 1 Zone Classification
Type Const.
Occupancy
Sprinklered
Otos ❑No ❑ Req'd.
Valuation 1 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
Split Entry
Split Level
Rancher
❑ NEW
❑ BLD.
❑ ALT.
❑ PLMB
❑ AO N.
MECH:
❑ RPL.
❑ M.H.
❑ MVE.
❑ POOL
0 OTHER
No. Baths
No. Floors
No. Rooms
Rec. Room
CERTIFICATE
of EXEMPTION
Req'd.
Rec'cI.
Not Req'd.
RIBE WORK
8. SCQ�f/(.%Y .t A/J l.C/ So keLoco4 1 &c /E.LE CTRIC
VALUATIONGASrce
of
9. Utilities
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 .1a2 —,3 — 7 9 SIGNATURE
DEPT.
SPECIAL APPROVALS'
REQ'D. REC'D.
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Zone Clearance
SEPA Checklist
SPECIAL CONDITIONS:
/2—‘3-79 R °UW octLQ.
DATE OFFICIAL'
APPROVED FOR ISSUANCE
FEES COLLECTED
Single
Building
Plumbing
Mech.
Plan Check
7J
SEPA
Mobile Home
Other (Specify)
.TOTAL $ 7
6
M
PERMIT NUMBER
79—(424.
DATE /2,-3-79
04* *7.00
*7.00
, 86212 .
12-03:;679
6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
12103N7191 86225 7,002p
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