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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 -