1984, 04-03 Permit: 84A-2864 AdditionPLAN NUMBER
APPLICATION /PERM IT
SPOKANE COUNTY - DEPARTMENT OF BUILDING & SAFETY
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456 -3675
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
STREET ADDRESS
E _ 1032 1 (4(
PARCEL NO.
I•/>44 -oS
LOT I BLOCK
2.1 I 2
SUBDIVISION
OWNER t
3. F(1 i
MAILING ADDRESS
_ y7
PHONE
RHONE
`124 — o 1&
LEGAL DESCRIPTION:
CONTRACTOR /1
4.
ADDRESS
LICENSE EXPIRES
,'c
DESIGNER
5. ADDRESS
PHONE
ZIP
PHONE
Actual Set Backs in Feet to:
North ('&r I = 'South if East -lq �t
1 .l West
Size of Par I
7 G , Zone CI sification
Typenpst�. `Occupancy .
NawConst. Valuation
C. 247
Residential
Commercia
Spr'nklered
❑Yes ❑No ❑Req'd.
Remodeled Valuation
CHANGE OF USE FROM
ZIP
TO
TYPE ❑ NEW ❑ ALT. 7$,AD'N. ❑ RPL. ❑ MVE.
7 ❑ OTHER
WORK BLD. ❑ PLMB. ❑ MECH. El M.H. ❑ POOL
Mai logy,
Upper Floors
No. Baths
Certif1. of Exempt.
or Variance
Uncv. Deck
Total Bldg. Floor Area
Garage /Storage
No. Floors
Greenhouse
Fin. Basement
No. Fin. Rooms
Required Yes El No
Received Yes❑ Nor-1
Unfin. Basement
No. Dwellings
Number
DESCRIBE WORK I ,
8. l�(��II� +� pi? P /Ti0 ! $ II
VALUATION
9.
SOURCE
UTILITIES
GAS
ELECTRIC
Shorelines /Flood Hazard
Yes❑ Not Applic. ❑
WATER SEWA E.
PUBLIC ❑ SEPTIC
PRIVATE ❑ SEWER
Ownership
Public ❑ Private ❑
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. T. -wanting of a permit does not presume to give au-
thority to violate or cancel the provisions of any oth- stat or local law regulating construction or the performance
of construction. SEE REVERS _ IDE F�O/R�REQ ;my' ' I . PECT • NS
SIGNATURE OF � eireAro
OWNER OR AGENT
APPLICATION
DATE
SPECIAL APPROVALS
PRELIM. FINAL
Env. i ;aitr
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
DATE
l i /
SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PERMIT IS NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
Plans Required ❑
Received ❑
FEES COLLECTED
Building r/7(1
Plumbing
Mech.
Plan Check
SEPA
Modular/
MFG. Home
Other (Specify)
TOTAL
4 =y
P R, IT NUMBER
*6800
*68.006
AL� *000
2863f
04 -03 -84
6479,
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATE455JEDo 3
'8 4
PERMITNO'. 6. 4 z
*68.00 OTAL