1984, 02-15 Permit: 84A-1306 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
N • .7-C..)1 -mss
PARCEL NO.
-7 50 - 03-2-1
LOT_
2.
OWNER
3.
BLOCK
SUBDIVISION
W C.�z l�441/4i:.l.E,t^1i N i b
PHONE
dv rJS
PHONE
LEGAL DESCRIPTION:
MAILING ADDRESS
N
1 G
ZIP
gCti-uxr
Actual Set Backs in Feet to:
North [South 1P..)
4.
CONTRACTOR
1M �. M wt 1k) -MN arx-E,
j�I/f1
LICENSE EXPIRES
PHONE
Size of Parcel
15X VAC.
11 Zone Classification
East 1 West
Residential
Commercial :
ADDRESS
ZIP
c:c 2 -
Type Const.
Occupancy
ia
Sprinklered
EYes Li No CReq'd.
5.
DESIGNER
ADDRESS
CHANGE OF USE FROM
6.
PHONE
ZIP
TO
TYPE L pitw ❑ ALT. 'AD' N.
7. OF
WORK BLD. ❑ PLMB. ElMECH.
RPL.
C M.H.
MVE.
n POOL C OTHER
N w Const. Valuation
,jeiU
Remode ed Valuation
Total Bldg. Floor Area
CC)
Main Floor
Upper Floors
Garage/Storage
Greenhouse
Cover Deck
Uncv. Deck
Fin. Basement
Unfin. Basement
No. Baths
No. Floors
Certitl. of Exempt.
a Variance
Required
Received
DESCRIBE WORK
8 t iAuNr�2 i2a>,r ADDtr't or i
LU 10
9 UTILOITIES
VA AT N SOURCE
GAS
Shorelines/ Flood Hazard
Yes❑ Not Applic. C
ELECTRIC
WATER
PUBLIC O
PRIVATE O
SEWAGE./
SEPTIC
SEWER O
Ownership
Public O 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
maimml
SPECIAL APPROVALS
PRELIM. FINAL DATE
APPLICATION
DATE
No. Fin. Rooms No. Dwellings
1 I.
YesC Nol?
Yes❑ No❑
Required yell/Received �{
Plans
Number
Env. Nnalth
*Iv=
L
/15
Planning
Fire
Prevent
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
/t
SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PERMIT IS NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
FEES COLLECTED
Building it. 32.0v
Plumbing
Mech.
Pian Check
SEPA
Modular/
MFG. Home
Other (Specify)
TOTAL $
PERMIT NUMBER
u2*
*32.00
*32.00`
*0.00
1DU.5
02-1 :-811
6479
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
64 t e
DATEI/SIED 1 5 4
PERMIT Jo2 a 6 z * 3 2. 0 UTOTa L
•
! ,r ROLLING DOORS & GRILLS HOLLOW METAL DOORS
TOILET PARTITIONS PANIC HARDWARE
Mel'S MAINTENANCE & CONSTRUCTION
GENERAL CONTRACTOR
License No ME LS -MC 221LR
RT 1, BOX 71 • MICA, WASHINGTON 99023
(509) 926-4195
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