1979, 11-21 Permit 79-8200 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 4 COPIES
JOB ADDRESS
1. '�J . . 2
LOT BLOC
OWNER
3
DDRESS
SUBDIV
1
PHONE
LEGAL DESCRIPTION - SEE ATTACHED
PARCEL NUMBER/S
Required Set Backs in Feet
North
CONTRACTOR
ADDRESS
��T rl• �, � r t
DESIGNER
5.
ADDRESS
CHANGE OF USE FROM
6.
PHONE
ZI P
PHONE
ZIP
TO
South East
Size of Parcel
TYPE
7. OF
WORK
❑ NEW
❑ BLD.
❑ ALT.
❑ PLMB.
❑ AD'N.
MECH:
❑ RPL.
❑ M.H.
❑ MVE.
❑ POOL
❑ OTHER
Type Const.
Occupancy
Zone Classification
Sprinklered
❑Yes ❑No ❑ Req'd.
Valuation (Building Area in Sq. Ft.
DWL Area
Split Entry
No. Baths
Basement Area 1 Garage Area
Split Level
No. Floors
Storage
Rancher
No. Rooms
Rec. Room
CERTIFICATE
of EXEMPTION
Req'd.
Rec'd.
Not Req'd
DESCRIBE WO
8. )
VALUATION
9
RK
ELECTRIC
Sour e
0
Utilities
GAS
WATEI
SEWER
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 1. al law regulating construction or the
performance of construction.
DATE / I— c) , SIGNATURE � �t [(c1 v \
DEPT.
SPECIAL APPROVALS
REQ'D. REC'D.
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Zone Clearance
SEPA Checklist
SPECIAL CONDITIONS:
/?
• DATE OFFICIA '- �
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL $ y
N1
PERMIT NUMBER
DATE j/—61` 7`7
04*
*7.00
*7,00
81 9,9R
11-21-79
2 6,479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
1.l ,--2'1'I-% 8 2 O. 0 z
*7,00,aP'
I KI CD Cl'Tf1D