1984, 02-24 Permit: 84A-1594 AdditionPLAN 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
1.
STREET ADDRESS
.2C21 . f LFour.-
LOT
2. Cea
3.
4.
5.
BLOCK
6
SUBDIVISION
PARCEL NO.
c✓ ri'5,/ I -f ✓ -4 t ' /cc r
OWNER
OA4-O& amts`.-
MAILING ADDRESS
PHONE
CONTRACTOR
�tcL- --'
ADDRESS
DESIGNER
PHONE
ZIP
LICEN E EXPI ES. PHONE
of /5- e�
Zqq we
ADDRESS
CHANGE OF USE FROM
6.
TYPE A, NEW
7. OF
WORK Y4- BLD•
LEGAL DESCRIPTION:
— 0 76' (;
Actual Set Backs in Feet to:
North �9I' .1. South •,LEast 61- / I West
Zone Classification
Size of Parcel
10 5'�( 32-3
PHONE
ZIP
TO
❑ ALT. AD' N. ❑ RPL. ❑ MVE.
❑ OTHER
❑ PLMB. ❑ MECH. ❑ M.H. ❑ POOL
Type COngt.
Occupancy
-j
N- Const. Valuation
Main Floor
Cover Deck
Residential
Commercia;1471.
Sprinklered
❑Yes No ❑Req'd.
Remodeled Valuation
Total Bldg. Floor Area
Upper Floors
No. Baths
Certifi. of Exempt.
or Variance
Uncv. Deck
Garage /Storage
Fin. Basement
No. Floors
No. Fin. Rooms
Greenhouse
Unfin. Basement
No. Dwellings
Required Yes❑ No❑
Received Yes ❑ Nor]
Number
8.
DESCRIBE WORK
VALUATION
9.
SOURCE
SEWAGE
OF SEPTIC
SEWS ❑
S
UTILITIES
GAS
ELECTRIC
WATER
PUBLIC
PR I VA
Shorelines /Flood Hazard
Yes❑ Not Applic. ❑
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 c. .cel the provisions of any other to or local law regulating construction or the performance
of construction. SERE ERSE SIDE FOR R IRE SPECTIONS
SIGNATURE OF
OWNER OR AGENT
SPECIAL APPR sjS SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
7
APPLICATION
DATE
PRELIM. Fl
Env. Health
Planning
DATE
4tJ0 Ci041 its`
7Z L[C • 54661 - ` 2,15 r-4
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
PERMIT IS NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
Plans Required ❑
Received G
FEES COLLECTED
Building
Plumbing
Mech.
Plan Check
SEPA
Modular/
MFG. Home
Other (Specify)
°
TOTAL $
7—
PERMIT NUMBER
4Y.4 I S — / j4
02* *4700
'v=47006
A *000
159,32
02 -24 -84
64.79.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
8 DATEQSaUEE2 4 8 4
PERMITAJ6. 9, 4 z * 4 7, 0 0 AL
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