1979, 11-08 Permit App: 79-7491 WoodstoveAFiFiLIVA 1 1%JN1 I01IMKMI 1
SPOKANE COUNTY — BUILDING CODES DEPARTMENT
NORTH 811 JEFFERSON./SPOKANE, WASHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 4 COPIES
JOB ADDRESS LEGAL DESCRIPTION — SEE ATTACHED
LOT BLOCK SUBDIVISION PARCEL NUMBER/S
2.
Orth South
East West
OW ERPHONE
� �
3. �
ZZ—
A DRESS
ZIP
CONTRACTOR
PHONE
4. ADDRESS
ZIP
DESIGNER
5.
PHONE
ADDRESS
ZIP
CHANGE OF USE FROM
6.
TO
DWL Area
TYPE IaNEW ❑ ALT. ❑ AD'N. ❑ RPL. ❑ MVE.
7 WORK 11 BLD. ElPLMB. (XMECH: ElM.H. El POOL
El OTHER
equired Set Backs in Feet
Orth South
East West
ize of Parcel
Zone Classification
on reverse side, and know the same to be true and correct. All provisions of laws and ordinances governing this
Building
Type Const.
Occupancy
Sprinklered
I
❑Yes ❑No ❑ Req'd.
aluation
Building Area in Sq. Ft.
Mech.
DWL Area
Basement Area
Garage Area
Storage
Env. Health
Split Entry
Split Level
Rancher
Mobile Home
Fire Marshall
No. Baths
F No. Floors
No. Rooms
Rec. Room
TOTAL $ F
Zone Clearance
CERTIFICATE
Req'd. I
Rec'd.
Not Rei
of EXEMPTION
1 1 - 0 UQp7 9 7 4�. z
DESCRIBE WO
8 (A )oo Cr 'Sf (� A �� FEES COLLECTED
`la I
DATE C% ly 9,9, 1 '�- 7�
04* *7.00
*7.00
749.02
11-08-79
2 6,479.
VALUATION Source GAS ELECTRIC WATER SEWER
of
9. Utilities
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
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
00
Mech.
SPECIAL APPROVALS SPECIAL CONDITIONS:
DEPT. REQ'D. RECD.
Plan Check
Env. Health
SEPA
Planning
Mobile Home
Fire Marshall
Co. Engineer
Other (Specify)
Utilities
�®
TOTAL $ F
Zone Clearance
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMESA PERMIT.
SEPA Checklist
DATE //-7-7-9 OFFICIAL
1 1 - 0 UQp7 9 7 4�. z
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RECORD OF INSPECTIONS
DATE REMARKS
Final Inspection
INSPECTED BY