1979, 09-28 Permit: 79-4979 Wood Stove PLAN NUMBER APPLICATION/PERMIT PERMIT NUMBER
SPOKANE COUNTY - BUILDING CODES DEPARTMENT '1 7g- /71479
NORTH 811 JEFFERSON / SPOKANE,WASHINGTON 99260 / (509) 456-3675 DATE q ".ZrS -79
APPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 4 COPIES SH -
04 * * 7.00
JOB ADDRESS LEGAL DESCRIPTION - SEE ATTACHED * 7,p p
LOT BLOCK SUBDIVISION PARCEL NUMBER/S 4 9 7.8
2. /�[,
OWNER J //�� �c7` PHONE 09-28-79
a ADDRESS � /` '11e P6-_527 Required Set Backs in Feet 6 4 7 9'
ZIP /_
lel-1 �/ 992€9 ' North ISouth East (West
CONTRACTOR PHONE Size of Parcel Zone Classification
4. ADDRESS ZIP Type Const. Occupancy Sprinklered
❑Yes ❑No ❑ Req'd.
DESIGNER PHONE Valuation Building Area in Sq. Ft.
5' ADDRESS ZIP DWL Area 1 Basement Area Garage Area Storage
CHANGE OF USE FROM TO Split Entry Split Level Rancher
6.
No. Baths No. Floors No. Rooms Rec. Room
TYPE 0 NEW ICALT. 0 AD'N. 0 RPL. 0 MVE.
7. OF 0 OTHER CERTIFICATE Req'd. Recd. Not Req'd.
WORK 0 BLD. 0 PLMB. ❑ MECH: ❑ M.H. ❑ POOL
of EXEMPTION
DESCRIBE WORK
8. `�sW� I� FEES COLLECTED
VALUATION Source GAS ELECTRIC WATER SEWER
of
9. Utilities Single $ -
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 Building
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
Plumbing
performance of construction. "�
DATE 9/ /7p SIGNATURE 4 - �= -.0,2-'7 Mech. ` , Cfrz9
SPECIAL APPROVALS SPECIAL CONDITIONS:
DEPT. REQ'D. REC'D. Plan Check
Env.Health
SEPA 2
r�
Planning G
—
uJ
Mobile Home `n
Fire Marshall -
Co. Engineer Other (Specify)
Utilities
TOTAL $ ` L9
Zone Clearance
�J�/ WHEN MACHINE VALIDATED IN THIS SPACE,
SEPA Checklist �%" O� THIS O ECOMEOSA�ERMIT. . ° o * 7. 0 0 O J
y--2 -79 a 200 ! i yr. , ci
DATE OFFICIAL
APPROVED FOR ISSUANCE —