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1984, 04-09 Permit: 84A-3116 Reroof, Reside Residence
PLAN NUMBER APPLICATION /PERMIT SPOKANE COUNTY — DEPARTMENT OF BUILDING & SAFETY NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456 -3675 1. STREET ADDRESS LOT 2. �1 APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES BLOCK Z SUBDIVISION 14:2 OWNER 3.14,,2`7, MAILING ADDRESS 4. CONTRACTOR 5411A -6 ADDRESS DESIGNER 5. ADDRESS PHONE PHONE "7"7 71 PARCEL NO. LEGAL DESCRIPTION: ZIP A ife...k LICENSE EXPIRES PHONE Actual Set Backs in Feet to: a North ISouth East Size of Parcel ZIP Type Cons -. Occupancy PHONE New Const. Valuation ZIP Main Floor West Zone Classification Residential Er Commercial ❑ Sprinklered ❑Yes ❑No ❑Req'd. 4odeled Valuation Upper Floors Garage /Storage Total Bldg. Floor Area Greenhouse 6. CHANGE OF USE FROM TO TYPE ❑ N W ❑ ALT. ❑ AD' N. E RPL. ❑ MVE. 7. OF WORK BLD. ❑ PLMB. ❑ MECH. ❑ M.H. ❑ POOL 8. - «.- 7- f5r DESCRIBE WORK Cover Deck Uncv. Deck Fin. Basement Unfin. Basement ❑ OTHER No. Baths No. Floors No. Fin. Rooms Certifi. of Exempt. or Variance Required Yes❑ Received Yes❑ No No No. Dwellings Number Shorelines /Flood Hazard Yes Not Applic. ❑ Plans Required ❑ Received ❑ VALUATION 9: SOURCE OF UTILITIES GAS ELECTRIC WATER PUBLIC ❑ PRIVATE ❑ SEWAGE SEPTIC ❑ SEWER ❑ Ownership Public ❑ Private Ilf I hereby certify that I have read and examined this application and have read the "NOT 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 au- thority to violate or cancel the provisions of any other state or local law regulating construction or the performance of construction. SEE RE RSE SIDE FOR REQUI D INSPECTIONS SIGNATURE OF / APPLICATI IN Air OWNER OR AGEN. AP. DATE SPECIAL APPR • VALS PRELIM. FINAL DATE Env. Health Planning Fire Prevent. Engineer Utilities SEPA Plans Exam. Building Tech. .92 SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE) * REP—rx C PERMIT IS NONTRANSFERABLE PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED IN 180 DAYS FEES COLLECTED Building 4.o • Plumbing Mech. Plan Check SEPA Modular/ MFG. Home Other (Specify) TOTAL $' ©c PERMIT NUMBER 02* *40.00 *40.00u A *0.00 311.5:g. 04 -09 -84 g 6479. 0 0 C.) W —J LL WHEN MACHINE VALIDATED IN THIS SPACE, THIS BECOMES A PERMIT. 04- 09=` {4 DATE ISSUED '5 116 *40.00ai. PERMIT NO. TOTAL