1981, 12-28 Permit: 81B-3014 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 3•COPIES
1.
2.
3
JOB ADDRESS
C C. 7SrJ Noep
LOT
BLOCK SUBDIVISION
•
OWNER
TSuiZiLNA R 'C
PHONE
LEGAL DESCRIPTION - SEE ATTACHED
PARCEL NUMBER/S
ADDRESS
`•iee
Nona
Z1P
GG 7-0G
Actual Set Backs in Feet
North (South East IWe
4.
CONTRACTOR
er5ipirvlin
ADDRESS
e7AY ME
PHONE
Size of Parcel
Zone Classification
ZIP
Type Con
Occupancy
Sprinklered
Oyes ONo 0 Req'd
5.
DESIGNER
PHONE
Valuation
Building Area In Sq. F
ADDRESS
ZIP
Main Floe
Upper Floor
Garage Area
Storage
CHANGE OF USE FROM
6.
TO
Area of Decks
Finished Basemen
Unfin. Basemen
TYPE
7. OF
WORK
iNEW 0 ALT. ❑0AD N. 0 RPL. 0 MVE.
0 BLD. 0 PLMB. NJ MECH. ' 0 M.H. 0 POOL
0 OTHER
No. Baths
No. Stories
No. Rooms
No. of Dwelling
CERTIFICATE
of EXEMPTION
Req'd
Rec'd.
Not Req'd.
DESCRIBE WORK
8. LOW -o'13u o r.) , r 3( Sro i E
VALUATION SOURCE GAS ELECTRIC
OF
9. UTILITIES
Enum. Dist.
Location (Area)
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 p
DATE OF APPLICATION — i 1 SIGNATURE OF APPLICANT 1 /L�J 6`
SPECIAL APPROVALS
NAME DATE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examine
SEPA Checklist
Building Technician
SPECIAL CONDITIONS:
PERMIT IS NONTRANSFERABLE
FEES COLLECTED
Single $
Building
Plumbing
Mech. . „ '1 too
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL
$fl.00
PERMIT NUMBER
S ' 3ca tar
04* *17.00
*17.00
301.38
1'2-28-8'1
6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
b4s ,
P,21142-18-,8 1.
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE DATE ISSUED
•
3101 4'z
PERMIT NO.
117.00RO
TOTAL