1979, 11-29 Permit 79-8521 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
2.
3
JOB ADDRESS
OC)terf irk A
LOT
BLOCK
SUBDIVISION
OWNERiW51'
CONTRACTORe
4. I*_�I
ADDRESS
DESIGNER
5.
ADDRESS
PHONE
ZIP
CHANGE OF USE FROM
6.
TYPE
7. OF
WORK
TO
PHONE
ZIP
VNEW ❑ ALT. AAD'N. ❑ RPL. ❑ MVE.
❑ BLD. ❑ PLMB. LJ MECH: ❑ M.H. 0 POOL
DESCRIBE WORK
NOC)P
VALUATION
9.
Source
of
Utilities
GAS
0 OTHER
ELECTRIC
LEGAL DE3CRIP%TION — SEE ATTACHED
PARCEL NUMBER/S
Required Set Backs in Fee
North
Size of
Parcel
Type Const.
South East
West
Zone Classification
Occupancy Sprinklered
❑Yes El No ❑ Req'd.
Valuation Building Area in Sq. Ft.
DWL Area
Split Entry
No. Baths
WATER
Basement Area Garage Area
Split Level
No. Floors No. Room
CERTIFICATE
of EXEMPTION
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 local law regulating construction or the
performance of construction.
DATE// _Fe)7
DEPT_
SPECIAL APPROVALS
REQ'D. REC'D.
SIGNATURE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Zone Clearance
SEPA Checklist
SPECIAL CONDITIONS:
DATE ///3 lJ
D FOR ISSUANCE
Storage
Rancher
Rec. Room
Req'd.
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL $
DATE
Nl
PERMIT NUMBER
7y-552i
04*
*7,00
*7,00
8520g
11-29-79
g 61479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
80215 7,Ou
INCDCf`T(1D