1979, 10-09 Permit: 79-5557 Wood StovePLAN NUMBER
(.,'1
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
JOB ADDRESS
r• •n
1. SOY O BLOCK S aOl 1510
2.
LEGAL DESCRIPTION — SEE ATTACHED
PARCEL NUMBER/S
OWNER •
3 (C;,isQ.(ll.P.
4.
5.
ADDRESS
tr , /ODD/
CONTRACTOR
ADDRESS
oi,/lrtil P
DESIGNER
;17 -aft gfrx/ Pi -
PHONE
ZIP
99:LOw!
Required Set Backs in Feet
North 'South
East
West
PHONE
Size of 'Parcel 1 Zone Classification
.ZIP
Type Const.
Occupancy
Sprinklered
Oyes ONo 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.
TO
Split Entry
Split Level
Rancher
TYPE
7. OF
WORK
\6.
O NEW
O BLD.
O ALT.
O PLMB.
0 AD N.
MECH:
O RPL.
O M.H.
❑ MVE.
0 OTHER
0 POOL
No. Baths
No. Floors
No. Rooms
Rec. Room
CERTIFICATE
of EXEMPTION
Req'd.
Rec'd. -
Not Req'd.
DESCRIBE WORK
\-141--4.121G11-11.4.k0-14 l Deu/Att /"q--5//-Evpt ,SLfru J
VALUATIONSource
GAS ELECT -RIC ATEW
ER
of
9. Utilities
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 /'D "9— 7 9 SIGNATURE-1L-212%�"'�
SPECIAL APPROVALS
DEPT. REO'O. RECD.
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Zone Clearance
SEPA Checklist
SPECIAL CONDITIONS:
DATE/19-9-7% OFFICIAI,R4JI feLFr^A./`-
APPROVED FOR ISSUANCE
FEES COLLECTED
Single $
Building
Plumbing
°
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL
PERMIT NUMBER
7� SSS7
DATE )U --9-799
04*
E
5556A
10-09-79
a 6479.
*7.00
*700 >n
'*7006
*000 8
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
11.0';t0 9.17 7'9 515'5.7 Z
*7.0:0 2F
CC
0
U
w
0
Z