1981, 01-20 Permit App: 81A-691 Wood StoveSPOKANE 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
1 -P -141,17L"'4
L EGArL DESCRIPTION — SEE ATTACHED
LOT I BLOCK ISUBDIVISION I PARCEL NUMBER/S
NER
aw�
PHONE
ADDRESS Q
ZIP
Actual Set Backs in Feet
Env. Health
`North
Fire Marshall
South
East West
CONTRACTOR
PHONE
Size of Parcel
Zone Classification
4'
AD,YRESS
ZIP
Type Con;Fj
Occupancy
Sprinklered
Oyes ❑No ❑ Req'd.
DESIGNER
PHONE
Valuation
Building Area in Sq. Ft.
5.
ADDRESS
ZIP
Main Floor
Upper Floors
Garage Area
Storage
CHANGE OF USE FROM
TO
Area of Decks
Finished Basement
Unfin. Basement
6.
TYPE El NEW El ALT. El AD'N. El RPL. El MVE.
No. Baths
No. Stories
No. Rooms
No. of Dwelling
7, OF El OTHER
n��1I
WORK El BLD. 1-1) PLMB. MECH. ❑ M. H. ❑ POOL
CERTIFICATE
Req'd.
Recd.
Not Req'd
of EXEMPTION
DE CRIBE WORK
Enum. Dist. Location (Area)
8.
FEES COLLECTED
VALUATION
SOURCE
G AfS
ELECTRIC
WATER
SEWER
Ownership
USE CODE
9.
I UTILOITIES
I
Public El Private ❑
Single $
1 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
Building
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
Plumbing
'A(
DATE OF APPLICATION -' f� —�� SIGNATURE OF APPLICANT
Mech.
SPECIAL APPROVALS
NAME DATE
SPECIAL CONDITIONS:
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL
WHEN MACHINE VALIDATED
THIS BECOMES A PERMIT.
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
IN THI
SEPA Checklist
/II is -&9/
04* * 1 7.00
*1700 to
69.'0
01-20-81
22 6,479,
I
ng Tec nicia PERMIT IS NONTRANSFERABLE 6 9. 1 z
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE DATE ISSUED PERMIT NO.
17.00°,1 --
TOTAL