1980, 12-01 Permit App 80B-4287 Wood StovePLAN NUMBER
PERMIT NUMBER
(0,
APPLICATION/PERMIT
SPOKANE COUNTY — BUILDING CODES DEPARTMENT
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES — DRESS HARD TO MAKE 3 COPIES
1.
2.
3
4.
JOB ADDRESS
`Z/ i'&. ,P
LO7 BLOCK SUBDIVISION
OWN-ER
.a-,L-IQ 11~Q
ADDRESS �%
, c c22 / i76 644,ta/pt/
CO TRACTOR
• L/}
RESS
PHONE
ZIP
PHONE
ZIP
LEGAL DESCRIPTION — SEE ATTACHED
PARCEL NUMBER/S
Actual Set Backs In Feet
North 'South
Size of Parcel
Type Const.
Occupancy
East
'West
Zone Classification
Sprinklered
Dyes ❑No ❑ Req'd.
5.
DESIGNER
PHONE
Valuation
Building Area In Sq. Ft.
ADDRESS
ZIP
Main Floor
Upper Floors 1 Garage Area
Storage
CHANGE OF USE FROM
6.
TO
Area of Decks
Finished Basement
Unfin. Basement
TYPE NEW
7, OF
WORK ❑ BLD.
❑ ALT.
❑ PLMB.
❑ AO N.
MECH.
❑ RPL.
❑ M.H.
❑ MVE.
❑ POOL
❑ OTHER
No. Baths
No. Stories
No. Rooms
No. of Dwellings
CERTIFICATE
of EXEMPTION
Req'd.
Rec'd.
Not Req'd.
DESCRIBE WORK
8. f1� rP c1 ) LIi�LGGLfic/ t»' i
VALUATION SOURCE GAS ELECTRIC
OF
9. UTILITIES
WATER
SEWER
Enum. Dist.
Ownership
Public ❑ Private ❑
Location (Area)
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 reguling construction or the
performance of construction. SEE REVERSE SIDE FOR REQUIRED INSPECTIONS
DATE OF APPLICATION /0`/'ryd
SIGNATURE OF APPLICANT
SPECIAL APPROVALS
NAME DATE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
SPECIAL CONDITIONS:
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL
M
04* *7.00
*7.00 In
*7.006
A *0.00
42862
1 2'-01 —80
2 6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
Building Tec ician
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
1 '2i b 01"-1$ b;
DATE ISSUED
PERMIT NO.
7. 0;0a°.1-.
—
TOTAL