1982, 09-20 Permit: 82A-8422 Wood StovePLAN NUMBER
APPLICATION/PERMIT
SPOKANE COUNTY — BUILDING CODES DEPARTMENT
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
APPLICANT:
JOB ADDRESS
1. 5, 3807 M oFFET
LOT
OWNER
RPY s1LGE.L
2.
3.
COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 3 -COPIES
T
LEGAL DESCRIPTION - SEE ATTACHED
BLOCK
SUBDIVISION
PHONE
`IZG-2o01
PARCEL NUMBER/5
ADDRESS
S. 3807 MoFFI-T
ZIP .
cnzo6
Actual Set Backs in Feet
North 'South
East
(West
4.
CONTRACTOR
snm+<
ADDRESS
PHONE
Size of Parcel 1 Zone Classification
ZIP
Type Const.
Occupancy
Sprinklered
DYes ❑No 0 Req'd.
5.
DESIGNER
PHONE
Valuation 'Building Area In Sq. Ft.
ADDRESS
ZIP
Main Floor
Upper Floors I Garage Area
Storage
CHANGE OF USE FROM
6.
TO
Area of Decks
Finished Basement
Unfin. Basement
TYPE
7. OF
WORK
4S NEW ❑ ALT.
0 BLD. 0 PLMB.
❑ AD N. 0 RPL. 0 MVE.
Er-MECH. 0 M.H. 0 POOL
❑ OTHER
No. Baths
NO. Stories
No. Rooms
No. of Dwellings
CERTIFICATE
of EXEMPTION
Req'd.
Recd.
Not Req'd.
DESCRIBE WORK
8. Woob SrtV . !t s rw-J r)oH
VALUATION
GAS
9.
SOURCE
OF
UTILITIES
Enum. Dist. I Location (Ar a)
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)IGNATURE OF APPLICANT
SPECIAL APPROVALS
NAME DATE
Env. Health
Planning
Fire Marshall
Co. Engineer
Ut 11 it les
Plans Examiner
SEPA Checklist
Building Technician
SPECIAL CONDITIONS:
. PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
FEES COLLECTED
•
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
/0
/ U(c- 00
Other (Specify) 'Q
p0.
TOTAL $ 20%.
PERMIT NUMBER
?2A-
04*
*2000
*2000 5
84218
092'0-82
2 6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
Q'17� e1:�2+0' 8121
842.21 *100021e
DATE ISSUED PERMIT NO. TOTAL
›-
LL
LL