HomeMy WebLinkAbout1984, 01-13 Permit: 84A-327 InsertPLAN NUMBER
APPLICATION /PERMIT
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
LOT
2.
BLOCK
SUBDIVISION
OWNER R JAc-kvi
3. geOlefe
PONE
2L). 614
PHONE
MV LING NG ADDRESS
t/! 2, 03 /P10 /tog Qourtf
C yTRACTOR
4 t fiebvRi e
ADDRESS
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DESIGNER
5.
ADDRESS
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LICENSE EXPIRES
ZIP
PHONE
qi %- ,S-917k
CHANGE OF USE FROM
TO
ZIP
g,2177-q6,72
PHONE
ZIP
TYPE ,,. NEW ❑ ALT. ❑ AD' N. ❑ RPL. ❑ MVE.
7 WORK ❑ BLD. ❑ PLMB.. /MECH. ❑ M.H. ❑ POOL ❑ OTHER
ESCRIBE WORK
8. e
a.)2.-td
VALUATION
9.
SOURCE
OF
UTILITIES
GAS
ELECTRIC
WATPR
PUBLIC ❑
PRIVATE ❑
SEWAGE
SEPTIC ❑
SEWER ❑
PARCEL NO.
LEGAL DESCRIPTION:
Actual Set Backs in Feet to:
North South
Size of Parcel
Type Const.
Occupancy
New Const. Valuation
Main Floor
Cover Deck
No. Baths
East West
Zone Classification
Residential El
Commercial ❑
Spr'nklered
❑Yes DNo ❑Req'd.
Remode ed Valuation
Upper Floors
Total Bldg. Floor Area
Garage /Storage
Uncv. Deck
No. Floors
Certifi. of Exempt.
or Variance
Greenhouse
Fin. Basement
No. Fin. Rooms
Required Yes No
Received Yes Non
Shorelines /Flood Hazard
Yes❑ NotApplic. ❑
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. 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 REVERSE SIDE FOR REQUIRED INSPECTIONS
SIGNATURE OF
OWNER OR AGENT
APPLICATION
DATE
Unfin. Basement
No. Dwellings
Number
Plans
Required ❑
Received ❑
SPECIAL APPROVALS L'
PRELIM. FINAL DATE
Env. Health",
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
Plans
Exam.
Building
Tech.
On�{�XYK
PERMIT IS NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
FEES COLLECTED
Building
Plumbing
Mech.
Plan Check
SEPA
Modular/
MFG. Home
Other (Specify)
TOTAL $ Cam°
PERMIT NUMBER
0 4 27
04*
*2000
*20.006
*0.00 ES
32.62
01 -13 -84
6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
n 11 F i
DATidI9SOEli 3 - 84 4
PERMIT NO.
3'27 z
TOTAL
*20.00 °�