1980, 02-08 Permit: M80-1021 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 4 COPIES
1.
2.
3.
4.
JOB ADDRESS Ir% IP 4 ✓ /1 vV
LOT SUBDIVISION
BLOCK
LEGAL OESCRIPTION - SEE ATTACHED
OWNEIR NA r\cH �L—(
PHONE
PARCEL NUMBER/S
ADD S�l� - 1014
CON RACTO
ADDRESS
PHONE
Required Set Backs in Feet
North 'South (East (West
Size of Parcel 1 Zone Classification
ZI P
Type Const.
Occupancy
Sprinklered
❑Yes ❑No ❑ Req'd.
DESIGNER
5. ADDRESS
PHONE
Valuation 1Building Area in Sq. Ft.
ZIP
DWL Area 1 Basement Area
Garage Area
Storage
CHANGE OF USE FROM
6.
TYPE
7. OF
WORK
TO
Split Entry
Split Level
Rancher
❑ NEW
❑ BLD.
❑ ALT. ❑ AD N. ❑ RPL. ❑ MVE.
❑ OTHER
❑ PLMB. ❑ MECH:❑ M.H. ❑ POOL
No. Baths
No. Floors No. Rooms
Rec. Room
il
CERTIFICATE Req'd.
of EXEMPTION
Rec'd.
Not Req'd.
8.
DESCRIBE WORK
0019
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 of construction. /
DATE
SIGNATURE •//�/I i�'t �%
DEPT.
SPECIAL APPROVALS
REQ'D. REC'D.
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Zone Clearance
SEPA Checklist
SPECIAL CONDITIONS:
FEES COLLECTED
Single $
Building
Plumbing �7
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL $ 7, 00
t1
PERMIT NUMBER
DATE
04*
*7.00
*7.00 to -
10202
02-08-80
64.79.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
102.12 *7,00
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