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1979, 10-30 Permit: 79-6974 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. JOB ADDRESS (o UO / 11011,1)1D'il `Y LOT BLOCK SUBDIVISI 2. LEGAL DESCRIPTION — SEE ATTACHED PARCEL NUMBER/S 3. 4. 5. D of ►t1 FLA ADDREfV/�SS&�7 MO hi 4/1 eier CONTRACTOR C I P ONE 3787 1531- (IDI 9zo� Required Set Backs in Feet North 'South East 'West PHONE Size of Parcel - •l Zone Classification ADDRESS DESIGNER ZIP Type Const. Occupancy Sprinklered ❑Yes ❑No 0 Req'd. • 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 Split Entry Split Level Rancher IE NEW 0 ALT. 0„, �AAD N. 0 RPL. 0 MVE. ❑ BLD. 0 PLMB. IfPMECH: - ❑ M.H. 0 POOL 0 OTHER No. Baths No. Floors No. Rooms Rec. Room CERTIFICATE - of EXEMPTION Req'd. Rec'd. Not Req'd. 9. 9. DESC RIB�E!/�K sTO V V (III I -c VALUATION Source of Utilities G S ELECTRIC WATER SEWER I hereby certify that I have read and examined this applica ion 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 lS2---C-7-567/ /7C 7f- SIGNATURE 'DEPT. SPECIAL APPROVALS REQ'D. REC'D. Env. Health Planning Fire Marshall Co. Engineer Utilities Zone Clearance SEPA Checklist SPECIAL CONDITIONS: DAT E42 FPI APPR ! "1R ISSUANCE - FEES COLLECTED Single $ Building Plumbing Mech. 7, OO Plan Check SEPA Mobile Home Other (Specify) TOTAL $ PERMIT NUMBER 72 -071- DATE 04* *7.00 *700 En • *7,008 B *aoo 8 697.3E 10—'30-79 B 6479. WHEN MACHINE VALIDATED IN THIS SPACE, THIS BECOMES A PERMIT. 10k130'"179 697.42 *7.0:0°.�