1981, 12-17 Permit 81B-2821 Wood StoveAPPLICATION/PERMIT
SPOKANE COUNTY — BUILDING CODES DEPARTMENT
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
1.
2.
3.
4.
JOB ADDRESS
APPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 3 COPIES
. ib�- T�-
LOT
BLOCK SUBDIVISION
OWNER
ADDRESS
CONTRACTOR
Ci utVln.0
ADDRESS
DESIGNER
5.
ADDRESS
6.
LEGAL DESCRIPTION - SEE ATTACHED
PARCEL NUMBER/S
PHONE
ZI P
PHONE
ZI P
Actual Set Backs in Feet
North 'South East [West
Size of Parcel Zone Classification
Type Const.
PHONE
Valuation
Occupancy Sprinklered
❑Ves ❑No ❑ Req'd.
Building Area in Sq. Ft.
CHANGE OF USE FROM
TYPE
7. OF
WORK
ZI P
Main Floor
Upper Floors
Garage Area
Storage
TO
dNEW ❑ ALT. ❑AAD'N. ❑ RPL. ❑ MVE.
❑ BLD. ❑ PLMB. LN MECH. ❑ M.H. ❑ POOL
DESCRIBE WORK
Area of Decks
Finished Basement
Unfin. Basement
❑ OTHER
No. Baths
No. Stories
No. Rooms
No. of Dwellings
CERTIFICATE
of EXEMPTION
Req'd.
Rec'd.
Not Req'd.
8. U,J cc> b t..>,� iN) 0\3 cy
VALUATION SOURCE GAS
OF
9. UTILITIES
ELECTRIC
WATER
SEWER
Enum. Dist.
Ownership
ILocation (Area)
USE CODE
Public 0 Private 0
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. Alt 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 )2 - ) 7 -
SPECIAL APPROVALS
NAME DATE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
SIGNATURE OF APPLICANT 2 �Lt>1R E. O.L. Yi
SPECIAL CONDITIONS:
FEES COLLECTED
Single $
Building
Plumbing
Mech. 'l�•OG
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL $ 17.oO
i1
PERMIT NUMBER
4i3-
04* * 1 7.00
*17,00
285.02
1 2-17-81
2 6,479,
Y
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
Building Technician
1 7'-8'1' 285.1z *17,004g —
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE DATE ISSUED PERMIT NO. TnTAI
PERMIT IS NONTRANSFERABLE