1979, 10-09 Permit: 79-5568 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 4 COPIES
JOB ADDRESS
,.�
/57J7
LOT CK
2. 3
El—O�-T 4-1-'
LEGAL DESCRIPTION - SEE ATTACHED
SUBDIVISION
OWNER
3. r CfJG�
4.
ADDRESS
CONTRACTOR
(24-7E-77?- 7f b
a L -YC
5EC vNb 4- Ugr
PHONE
7 zi-e?/6
PHONE
PARCEL NUMBER/S 235:11 - 320 3
Required Set Backs in Feet
North 'South
East (West
Size of Parcel 1 Zone Classification
J/ )f_Le- F/I1-} i &,
ADDRESS
ZI P
Type Const.
Occupancy
Sprinklered
Oyes No ❑ Req'd.
DESIGNER
5. ADDRESS
PHONE
Valuation 1Building 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
❑ NEW ❑ ALT.
❑ BLD. ❑ PLMB.
❑ AD'N.
❑ RPL.
ECH: ❑ M.H.
❑ MVE.
❑ POOL
❑ OTHER
No. Baths
NO. FlOors
No. Rooms
Rec. Room
CERTIFICATE
of EXEMPTION
Req'd.
Rec'd.
Not Req'd.
DESCRIBE WORK
8. )
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 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 ofonsjruction.
DATE
9 (79
SIGNATURE
DEPT.
SPECIAL APPROVALS
REQ'D. REC'D.
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Zone Clearance
SEPA Checklist
SPECIAL CONDITIONS:
yik2
DATE (0q_ 7ef OFFICIAL -_ / ca../tii
APPROVED FOR ISSUANCE
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL
7 _cmc
11
DATE /o -47' 7i
PERMIT NUMBER
77 - S,5L
04*
*7.00
*7.00 5
556.7
10-09-79
6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
556.82