1980, 03-07 Permit: 80-1905 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 TU MAKE 4 COPIES
1.
2.
3.
JOB ADDRESS
I—Jzz 5. PioRRpL
LOT BLOCK SUBD V ON
LEGAL DESCRIPTION - SEE ATTACHED
PARCEL NUMBER/S
OWNER
RaiAnea
ADDRESS
1-7?? s
1 f�GyvA(..O
iP18 rc.rt.ow
PHONE
ZIP
'%1i 21 C.
Required Set Backs in Feet
North (South
East
W est
4.
5.
CONTRACTOR
SAk vrl E
PHONE
Size of Parcel
Zone Classification
ADDRESS
DESIGNER
ADDRESS
ZIP
Type Const.
Occupancy
Sprinklered
❑Ves ONO ❑ Req'd-
PHONE
Valuation
Building Area in Sq. Ft.
ZIP
DWL Area I Basement Area r Garage Area
Storage
CHANGE OF USE FROM
6.
TO
Split Entry
Split Level
Rancher
TYPE
7. OF
WORK
X NEW
❑ BLD.
o ALT.
❑ PLMB
0 AD N.
MECH
❑ RPL-
❑ M.H.
❑ MVE.
❑ POOL
0 OTHER
No. Baths
No. Floors
No. Rooms
Rec. Room
CERTIFICATE
of EXEMPTION
R eq'd.
Recd.
Not Req'd.
DESCRIBE WORK
8. I f STN}Ll.- W 00D 5YOU E
VALUATION
9.
Source
of
Utilities
GAS
ELECTRIC
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 correc . 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 II cal law regulating construction or the
performance of construction.
DATE 791d
SIGNATURE Laf.IC.i
/
/ SPECIAL APPROVALS
DEPT- REQ'D.
REC'D.
Env. Health
Planning
Fire Marshall
Co- Engineer
Utilities
Zone Clearance
SEPA check Iii `t HOME OWNER'S WARRANTY
SPECIAL CONDITIONS:
VES C )17/50
/
NO DATE /7/5o OFFICIAL [-
S
APPROVED 0 IS ANCE
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Horne
Other (Specify)
TOTAL
.00
$ -g00
PERMIT NUMBER
DATE 3/P80
04* *7.00
*7.00
*7.006
E *000
190.42
03-07'-80
2 6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
05::0.7'B"01
190,52 *7,0,0,Rp
0
U
w
0
0