1979, 12-18 Permit: 79-9273 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
JOB ADDRESS
\0. 1104- 1PS9iR
LOT
BLOCK SUBDIVISION
KO
LEGAL DESCRIPTION - SEE ATTACHED
wlo
3 DAD I1E S 1104' 121R014-1
has
PARCEL NUMBER/S
Required Set Backs in Feet
North !South East (West
PHONE
ZIP
Size of Parcel Zone Classification
Type Const.
Occupancy Sprinklered
❑Yes ❑No ❑ Req'd.
DESIGNER
5. ADDRESS
PHONE
Valuation Building Area in Sq. Ft.
ZIP
DWL Area I Basement Area
Garage Area
Storage
CHANGE OF USE FROM
6.
TO
Split Entry
Split Level
Rancher
TYPE
7. OF
WORK
N2KIEW ❑ ALT. D AD'N. ❑ RPL. ❑ MVE.
❑ BLD. ❑ PLMB. I'MECH: ❑ M.H. ❑ POOL
❑ OTHER
No. Baths
No. Floors
No. Rooms
Rec. Room
CERTIFICATE
of EXEMPTION
Req'd.
Rec'd.
Not Req'd.
DESCRIBE WORK
1A1(9°19
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 correct. All provisions of laws and ordinances governing this
type of work will be complied with whether specified herein .Q•. The granting of a permit does not presume
to give authority to violate or cancel the provisions of any oth e or local law relating construction or the
performance of construction.
DATE
SIGNATURE
DEPT.
SPECIAL APPROVALS
REQ'D. REC'D.
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Zone Clearance
SEPA Checklist
SPECIAL CO DITIONS:
DATE
AP S% OR ISSUANCE
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL $
7, UO
DATE
PERMIT NUMB
"773
04* *7.00
*7:(00
*7.00
E *U.00
927.2
12-18-79
6,479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
12-=18-7'9
0
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