1979, 10-30 Permit: 79-6972 WoodstovePLAN NUMBER
APPLICATION/PERMIT
SPOKANE COUNTY — BUILDING CODES DEPARTMENT
PERMIT NUMBER
7`f-- 9 7.1
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675 DATE /0—<--0
APPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 4 COPIES
JOB ADDRESS
LOT
BLOtR
2.
OVyNER
ADDRESS
�! s
t
CONTRACTOR
4.�.t2�2LC/_
ADDRESS
I , y, J7i
SUBDIVISION
PHONE
ZIP
`?c D/‘^
PHONE
LEGAL DESCRIPTION - SEE ATTACHED
PARCEL NUMBER/S
Required Set Backs in Feet
'South
North
East 'West
Size of Parcel 1 Zone Classification
ZI P
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
❑ NEW
❑ BLD.
O ALT. ❑ AD'N. 0 RPL. 0 MVE.
❑ PLMB. MECH: 0 M.H. 0 POOL
0 OTHER
No. Baths
No. Floors
No. Rooms
Rec. Room
CERTIFICATE
of EXEMPTION
Req'd.
Recd.
Not Req'd.
8. i :r_tf .a4. c C-1 ,G %-�"-ai-i&
VALUATION Source
of
9. Utilities
G
AS ELE TRIC 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 l9 Iaw.Fegu, atitlg co+j struc)i9n or the
performance of construction.
DATE /�"-30 7 / pSIGNATURE
DEPT.
SPECIAL APPROVALS
REQ'D. REC'D.
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Zone Clearance
SEPA Checklist
SPECIAL CONDITIONS:
, 79 J����111
DATE OFFICIAL�'�ai/ d/�
APPROVED FOR ISSUANCE
FEES COLLECTED
Single $
Building
Plumbing
D
Mech. 7 4'
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL $ �"
04*
*7.00
*7.00
697.1 g
10-30-79
2 6479,
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
u—.i30=79 69'7,22
* 7.O 0 a'� 1
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