1981, 09-30 Permit: 81B-0051 WoodstovePLAN 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
JOB ADDRESS
1 t �,{1'Y� {
LOT BLO�KSUBDIVISION
2.
LEGAL DESCRIPTION — SEE ATTACHED
PARCEL NUMBER/S
OWNER
3. � �� ►• rn (--Da MCC._
ADDRESS
4.
CONTRACTOR
PHONE
ZIP
ct C.t 2 c;
PHONE
Actual Set Backs in Feet
North 'South `East 'West
Size of Parcel I Zone Classification
ADDRESS
ZIP
Type Const.
Occupancy
5.
6.
DESIGNER
ADDRESS
PHONE
Sprinklered
❑Yes ❑No ❑ Req'd.
Valuation Building Area in Sq. Ft.
CHANGE OF USE FROM
ZIP
Main Floor
Upper Floors
Garage Area
Storage
TO
Area of Decks
Finished Basement
Unfin. Basement
TYPE
7. OF
WORK
NEW
❑ BLD.
❑ ALT.,❑.J AD'N. ❑ RPL. ❑ MVE.
❑ PLMB. h(J MECH, ❑ M.H. 0 POOL
DESCRIBE WORK
8. i;rl)C0-013L1(Z-N I.tiC\
VALUATION
9.
SOURCE
OF
UTILITIES
0 OTHER
No. Baths
No. Stories
No. Rooms
No. of Dwellings
CERTIFICATE
of EXEMPTION
Req'd.
Rec'd.
Not Req'd.
i n;e.-r
Enum. Dist. I Location (Area)
GAS
ELECTRIC
WATER
SEWER
Ownership
Public ❑ Private ❑
USE CODE
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
to give authority to violate or cancel the provisions of any other state or local law regulating construction or the
performance of construction. EE F VERSE SIDE FOR REQUIRED INSPECTION•
7
DATE OF APPLICATION
SPECIAL APPROVALS
NAME DATE
9
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
Bung Tnician
1 SIGNATURE OF APPLICANT
SPECIAL CONDITIONS:
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
FEES COLLECTED
Single $
Building
Plumbing
Mech. t+ 17 :co
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL
$ Its . CJe
PERMIT NUMBER
8 t - c.x>S I
04* *17.00
* 1 7.00 tn
* 17.00,5
A *0,00
5.'0g
09-30-81
6.479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
091-X50-81' S1 z *1.7,00a172
DATE ISSUED PERMIT NO. TOTAL
O
CJ