1980, 12-10 Permit: 80B-4727 WoodstovePLAN NUMBER
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��,�/�� 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. 6!
LOT BLOCK SUBDI 10 V
2.
LEGAL DESCRIPTION — SEE ATTACHED
PARCEL NUMBED/S
PHONE
q�- /576
ADDRESS
ei /43/
C9VTRACTOR
4
ADDRESS
e 3 / Ga / / ro . • GkiX
DESIGNER
5' ADDRESS
ZIP
9.2/
Actual Set Backs in Feet
North 'South East 'West
PHONE
_10.71-317116)
Size of Parcel 1 Zone Classification
ZIP
CIy,2v,5
Type Const.
Occupancy
Sprinklered
❑Yes ❑No 0 Req'd.
PHONE
Valuation 7
O!7
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
7. OF
WORK
❑ NEW
❑ BLD.
❑ ALT.
❑ PLMB.
❑ AD N.
,x MECH.
❑ RPL.
❑ M.H.
❑ MVE.
❑ POOL
0 OTHER
No. Baths
No. Stories
No. Rooms
No. of Dwellings
CERTIFICATE
of EXEMPTION
Req'd.
Recd.
Not Req'd.
DESCRIBE WORK
8. z CE
V LUAT.00 S U OF
9. 711 UTILITIES
GAS
ELECTRIC
WATER
SEWER
Enum. Dist. I Location (Area)
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 r
DATE OF APPLICATION / 4- -1 d-- 6e)
SPECIAL APPROVALS
NAME DATE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
B ilding Te niciayg
SIGNATURE OF APPLICAN
SPECIAL CONDITIONS:
„
/.e) -G -
PERMIT IS NONTRANSFERABLE
FEES COLLECTED
Single $
Building
Plumbing
D
Mech. /
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL
$/3
PERMIT NUMBER
4L3— 7 Z 7
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
1.7 t 1 `1'8 '0 47 2 7 'z*13.002F-1