1981, 10-02 Permit M81B-0160 Wood StovePLAN NUMBER
APPLICATION/PERMIT
SPOKANE COUNTY - BUILDING CODES DEPARTMENT
rPERMIT NUMBER
v 1 7 - 0 16,o
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 3 COPIES
1.
2.
3.
4.
JOB f�DDR4S9 I� I ' + _Ifs .
LOT BLOCK IL{��j�!
1? Z
W ONE
OWNER iiN1� \'/ti - �
ADDF ESS
13 jSte,}
(O E
) -(2-
PHONE
LEGAL DESCRIPTION - SEE ATTACHED
PARCEL NUMBER/S
Actual Set Backs in Feet
North 'South lEast (West
Size of Parcel I Zone Classification
ADDRESS
ZIP
Type Const.
Occupancy
Sprinklered
Elves ❑No ❑ Req'd.
DESIGNER
5' ADDRESS
PHONE
Valuation Building Area in Sq. Ft.
ZIP
Main Floor
Upper Floors 1 Garage Area
Storage
CHANGE OF USE FROM
6.
TYPE
7, OF
WORK
TO
EKNEW ❑ ALT. D;AD_'N. ❑ RPL. ❑ MVE.
D BLD. ElPLMB. Ld MECH. ❑ M.H. ❑ POOL
DESCRII3E WORK
8. 1.44 cic.W
OTHER
Area of Decks
No. Baths
Finished Basement
No. Stories
No. Rooms
Unfin. Basement
No. of Dwellings
CERTIFICATE
of EXEMPTION
Enum. Dist. I Location (Area)
Req'd.
VALUATION
9.
SOURCE
OF
UTILITIES
GAS
ELECTRIC
WATER
SEWER
Ownership
Public ❑ Private ❑
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 INSPECTION
DATE OF APPLICATION /0 L SIGNATURE OF APPLICANT
SPECIAL APPROVALS SPECIAL CONDITIONS:
NAME DATE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
Rec'd.
Not Req'd.
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
17,
TOTAL $ 1.7 '
0L * * 1 7,00
*17.00
* 1 7.006
A *000
159
'10-02-81
2 6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
�O02'-8`l
16.0g
DATE ISSUED PERMIT NO.
*17,OOaiJ-
TOTAL
1
0
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