1981, 09-11 Permit: M81A-9179 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 3 COPIES
JOB ADDRESS
12016 E. 12th
LEGAL DESCRIPTION — SEE ATTACHED
2.
3.
LOT
BLOCK
SUBDIVISION
OWNER
Jacobson
PHONE
926-8052
PARCEL NUMBER/S
ADDRESS
12016 E. 12th Spokane, WA
ZIP
99206
Actual Set Backs in Feet
North 'South East (West
4.
CONTRACTOR
Valley Fireplace, Inc.
PHONE
Size of Parcel Zone Classification
ADDRESS
E. 16610 Sprague Ave. Veradale,
AzIP99037
Type Const.
Occupancy Sprinklered
❑Yes ❑No ❑ Req'd.
5.
DESIGNER
Contractor Specialty
PHONE
Valuation
Building Area in Sq. Ft.
ADDRESS
NO. VA LL EF 626 07.7
ZIP
Main Floor I Upper Floors
Garage Area
Storage
CHANGE OF USE FROM
6.
TYPE
7. OF
WORK
TO
Area of Decks
Finished Basement
Unfin. Basement
❑ NEW
❑ BLD.
O ALT.
❑ PLMB.
❑ AD'N.
O MECH.
❑ RPL.
❑ M.H.
❑ MVE.
0 POOL
[0 OTHER
No. Baths
No. Stories
No. Rooms
No. of Dwellings
CERTIFICATE
of EXEMPTION
Req'd.
Rec'd.
Not Req'd.
DESCRIBE WORK
VALUATION
9.
Install Blaze Princess
tknney and fire walls.
SOURCE
OF
UTILITIES
GAS
ELECTRIC
,00dstove with
Enum. Dist.
ILocation (Area)
WATER
SEWER
Ownership
Public ❑ Private ❑
USE CODE
I hereby certify thai 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 of construction. SEE REVERSE SIDE FOR REQUIRED INSPECTIONS
DATE OF APPLICATION
SIGNATURE OF APPLICAN7r�,r�""�'4
fii�fl
SPECIAL APPROVALS
NAME DATE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
Bui
g T
4 iaan
P.e' 9
PECIAL CONDITIONS:
Ready now for inspection.
PERMIT IS NONTRANSFERABLE
DCRMIT CYPIRCC r1MC VCAR C12r1M IIATC r1C 'CCI IAKIPC
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL
$
PERMIT NUMBER
?C31 -01
04* *17.00
* 17.00 175
* 17.006
A *000
917.82
09-11-81
2 6 4 7 9,
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
• i
09,-11'_81
nnTC ICC! IC,
9 17.9 z
*17.00a- _