1981, 10-20 Permit App: 81B-864 Wood 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
N. 1/-o‘, coRBIN ROAD
LOT
BLOCK
SUBDIVISION
LEGAL DESCRIPTION - SEE ATTACHED
PARCEL NUMBER/S
OWNER
3. 5 -rEVE. 1411-1__
ADDRESS
tM (food CC(2.17,04 'i.OIkP GR0.M/04s
PHONE
'2Z. -1i
ZIP
99016
CONTRACTOR
4 SAtA£
PHONE
Actual Set Backs in Feet
North (South
East (West
Size of Parcel ) Zone Classification
' ADDRESS
ZIP
Type Const.
Occupancy
Sprinklered
Yes No ❑ Req'd.
DESIGNER
5.
ADDRESS
PHONE
Valuation Building Area in Sq. Ft.
ZIP
Main Floor
Upper Floors I Garage Area
Storage
CHANGE OF USE FROM
6.
TO
Area of Decks
Finished Basement
Unfin. Basement
TYPE
7, OF
WORK
IBJ NEW ❑ ALT. ❑ AD'N. ❑ RPL. ❑ MVE.
❑ BLD. ❑ PLMB. Ej'1ECH. ❑ M.H. ❑ POOL
❑ OTHER
No. Baths
No. Stories
No. Rooms
No. of Dwellings
CERTIFICATE
of EXEMPTION
R
eq'd.
Rec'd. Not Req'd.
DESCRIBE WORK
8. Wocp -TCYE INSTPJ. A, rTcN
VALUATION
SOURCE
OF
UTILITIES
GAS
9.
Enum. Dist. 'Location (Area)
ELECTRIC
WATER
SEWER
Ownership
Public ❑ Private 0
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 SIGNATURE OF APPLICANT
'eP
SPECIAL APPROVALS
NAME DATE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
Building Technician
SPECIAL CONDITIONS:
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
FEES COLLECTED
Single $
Building
Plumbing
Mech. X�
Plan Check
SEPA
Mobile Home
Lss .. � t �
Other (Specify) �� x
TOTAL $ L (,
PERMIT NUMBER
04* * 1 7.00
*17.00
*17006
A *000 8
863
10-20-81
2 6479,
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATE ISSUED
8642 *17002P
PERMIT NO. TOTAL
0
a
0
0
w
J
u -