1981, 02-17 Permit: 81A-1530 WoodstovePLAN 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
1004- ilJ[x:)P_Ak4',
LOT
BLOCK
SUBDIVISION
LEGAL DESCRIPTION - SEE ATTACHED
OWNER
L hL`
PHONE
(1.77.--003q
PARCEL NUMBER/S
ADDRESS
ZIP
Actual Set Backs in Feet
North !South [East (West
4.
CONTRACTOR
1"01-'1 F4sA r Lt4 (M(' _'4 J4uF
PHONE
747 -27b-7
Size of Parcel 1 Zone Classification
ADDRESS
ZIP
Type Const.
Occupancy
Sprinklered
❑Yes ❑No ❑ Req'd.
DESIGNER
5. ADDRESS
PHONE
Valuation !Building Area in Sq. Ft.
ZIP
Main Floor
Upper Floors 1 Garage Area
Storage
CHANGE OF USE FROM
6.
TYPE
7. OF
WORK
TO
Area of Decks
Finished Basement
Unfin. Basement
4 NEW
❑ BLD.
❑ ALT. ❑ AD'N. ❑ RPL. ❑ MVE.
❑ PLMB. ti(MECH. 0 M,H. ❑ POOL
❑ OTHER
No. Baths
No. Stories
No. Rooms
No. of Dwellings
CERTIFICATE
of EXEMPTION
Req'd.
Recd.
Not Req'd.
DESCRIBE WORK
8. LIJOCKLYEit(iQ11;i
Enum. Dist. I Location (Area)
VALUATION
9.
SOURCE
OF
UTILITIES
GAS
ELECTRIC
WATER
SEWER
Ownership
Public 0 Private ❑
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 grting of a permit does not presume
to give authority to violate or cancel the provisions of any other state or loclaw regulating cons tion or the
performance of construction. SEE REVERSE SIDE FOR REQUIRED INSPE I 'NS
DATE OF APPLICATION %'J7 (67 SIGNATURE OF APPLIC
SPECIAL APPROVALS
NAME DATE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
e9di�T chnician
c ��
SPECIAL CONDITIONS:
PERMIT IS NONTRANSFERABLE
FEES COLLECTED
Single $
Building
Plumbing
Mech. 117 \7
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL
$ (7.c(
'1
PERMIT NUMBER
t3I4't= 153c
04* * 1 7.00
* 1700 N
* 17.00
A 40, *0.00
152,92
+02-17-81
2 6479,
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
02;-17-81 155,02 *17.00aM -
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE DATE ISSUED PERMIT NO. TOTAL