1980, 04-02 Permit: M80-3013 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
2.
JOB ADDRESS
/fr., A45-0 =! /A 7'•`f
LOT BLOCK
LEGAL DESCRIPTION — SEE ATTACHED
SUBDIVISION
3.
4.
OWNER
A:61 C
ADDRESS
�./(/SO{/
CONTRACTOR
PHONE
9ZZ-/54/9/
ZIP
99037
PARCEL NUMBER/S
Actual Set Backs in Feet
North 15outh
East
(West
PHONE
Size of Parcel 1 Zone Classification
ADDRESS
ZIP
Type Const.
Occupancy
Sprinklered
❑Yes ❑No ❑ Req'd.
DESIGNER
5' ADDRESS
PHONE
Valuation 1Building Area in Sq. Ft.
ZIP
Main Floor
Upper Floors 1 Garage Area
Storage
CHANGE OF USE FROM
6.
TO
Area of Decks
Finished Basement
Unfin. Basement
7.
TYPE
OF
WORK
t NEW
❑ BLD.
❑ ALT.
❑ PLMB.
❑ AD'N.
MECH.
❑ RPL. ❑ MVE.
❑ OTHER
❑ M.H. ❑ POOL
No. Baths
No. Stories
No. Rooms
No. of Dwellings
CERTIFICATE
of EXEMPTION
Req'd.
Rec'd.
Not Req'd.
8.
9.
DESCRIBE WORK
/4)60 ,t?4 e/U/N/ STo v6
iNS 7114
VALUATION
Enum. Dist.
Location (Area)
SOURCE GAS ELECTRIC
OF
UTILITIES
WATER
SEWER
Ownership
Public ❑ Private ❑
USE CODE
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. SEE REVERSE SIDE FOR REQUIRED INSPECTIONS
DATE OF APPLICATION
SPECIAL APPROVALS
NAME DATE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
Buildj.g9 rchnician
-670
SIGNATURE OF APPLICANT
SPECIAL CONDITIONS:
PERMIT IS NONTRANSFERABLE
PERMIT FYPIDFQ (INF VFAD FDrr1A IIATF (IF IQQI ANr•F
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL
$ 7, o 0
11
PERMIT NUMBER
`-- .7, o6'
3O 12
PA -1 w
6.1 Art )
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
0'41-02--)0
nATC icci ,cn
501,32 *7,00
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