1979, 12-21 Permit: 79-9391 Wood Stove PLAN NUMBER APPLICATION/PERMIT ,�n PERMIT NUMBER
SPOKANE COUNTY — BUILDING CODES DEPARTMENT 1 v \ -in J -(A
NORTH 811 JEFFERSON / SPOKANE,WASHINGTON 99260 / (509) 456-3675 DATE
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 4 COPIES
1 JOB ADDRESS/ 1 O� * * � O O
(�' S� _(1 (� J LEGAL DERIP' ION — SEE ATTACHED
LOT BLOCK ABDIVISI6N �1 L'' PARCEL NUMBER/S t 7 O
2. 4-% 2-253 * 7,0 0 6
OWNER i PHONE E * 0 G U
3. ADDR� T � Z �-lna�� 939.0
P Required Set Backs in Feet
jO. cOj-ercyp__. North 'South East (West
1311.0-150..)
CTOR PHONE Size of Parcel Zone Classification 1 2-2 1 -7 9
4. ICA.k.pnAgn L/s 9-5417&' b 4 7 9.
ADDRES n ZIP Type Const. Occupancy Sprinklered z
.1 3 V-01•0--)
�1 . ')') ❑Yes ❑No ❑ Req'd.
DESIGNER PHO E W-� Valuation Building Area in Sq. Ft.
5' ADDRESS ZIP DWL Area 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 ❑ NEW ❑ ALT. ❑ AD'N. ❑ RPL. ❑ MVE.
7, OF ❑ OTHER
WORK ❑ BLD. ❑ PLMB. ❑ MECH: ❑ M.H. ❑ POOL CERTIFICATE Req'd. Rec'd. Not Req'd.
of EXEMPTION
DCSZBE WO
8. ., �/
(��._ �u� 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
performance of construction. Plumbing
DATE SIGNATURE Mech.
SPECIAL APPROVALS SPECIAL CONDITIONS:
DEPT. REQ'D. REC'D. Plan Check
Env. Health oc
SEPA o
Planning — w
a.
Mobile Home rn
Fire Marshall —
Co. Engineer Other (Specify) y
Utilities C.-,0TOTAL $ { _
Zone Clearance
WHEN MACHINE VALIDATED IN THIS SPACE,
SEPA Checklist L/ THIS BECOMES A'7PEnRMIT. z o O
DATE/�.J2OJ OFFICIAL V�Ci.rtn./V.A1-1^ . 12 2 r- !,7 3 9.1 Z * 7. 0,L) 2 F-j-
APPROVED FOR ISSUANCE _