1984, 03-07 Permit: 84A-1911 AdditionQLArJ 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.
LOT BLOCK SU DIVISION
2. 7 — bi y,t.,& } 2-7\10
OWNER i I PHONE
3 �. �.�LJ I N
MAILING ADDRESS
e 1e7 SI
STRET ADDRESS
PARCEL NO.
LEGAL DESCRIPTION:
PHONE
CONTRACTOR
4. HJ' Ni lt< * 5 -
ADDRESS I
r, )c- 71
DESIGNER
5.
ADDRESS
LICENSE EXPIRES
ZIP
�l�J l�
PHONE
72-6zip 415
7)x23
CHANGE OF USE FROM
6.
PHONE
Actual Set Backs In Feet to:
North I South I e [East I West
Size of Parcel
Zone Classification
Residential L3
Commercial ❑
Type
Occupancy
Sprinklered
[Wes ENo EReg 'd.
ZIP
TO
TYPE E NEW ❑ ALT. ,ErAD' N. r RPL.
7. OF
WORK BLD. E PLMB. ❑ MECH. C M.H.
DESCRIBE WORK
8. N Ih& I22ol1
9.
VALUATION SODUFCE
UTILITIES
i1/449+9iTi4\l
GAS
ELECTRIC
E MVE.
❑ POOL
WATER
PUBLIC
PRIVATE 0
❑ OTHER
New Const. Valuation Re mode ed Valuation
Total Bldg. Floor Area
Main Floor
(aC
Upper Floors
Garage/Storage
Greenhouse
Cover Deck
Uncv. Deck
Fin. Basement
Unfin. Basement
No. Baths
No. Floors
No. Fin. Rooms
No. Dwellings
Certifi. of Exempt.
or Variance
Required Yes❑ No❑
Received Yes Nof7
Number
SEWAG
SEPTIC
SEWER 0
Shorelines/Flood Hazard
Yes Not Applic.
Ownership
Public ❑ Private 0
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 . any other state or local law regulating construction or the performance
of construction. SEE REVERSE SID • EOUIRED INSPECTIONS
SIGNATURE OF
OWNER OR AGENT . e
SPECIAL APPROVALS S
PRELIM. FINAL DATE
Env. Health
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
77
APPLICATION
DATE
A.j IAL CONDITIONS: (SEE REVERSE SIDE FOR NOTI
PL11 I -T .b 6'* -
CiN� �,jo-ft
N" l:v4 -t'viA L. -54, pr,ut\LA A -1I( 11315°
-= 41 - Sk-2-(44-A- -13°4)
PERMIT IS NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
Plans Required
Received '1
FEES COLLECTED
Building
Plumbing
Mech.
Plan Check
SEPA
Modular /
MFG. Home
Ot r (Specify) 2"--2/
TOTAL $
PERMIT NUMBER
02*
* 22.00
* 22.00,
*0.00 El
191.0
03-07-84
479
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
03-07-84
DATE ISSUED
191.12 *22.00,9AL
PERMIT NO.
ROLLING DOORS & GRILLS HOLLOW METAL DOORS
TOILET PARTITIONS PANIC HARDWARE
Mel's MAINTENANCE & CONSTRUCTION
GENERAL. CONTRACTOR
License No. MELS-MC-221LR
RT. 1, BOX 71 • MICA, WASHINGTON 99023
(509) 9264195 a0 r R/ 4 e S/E
440A'Die/ Rcc ; AcQl,T,co
cvs7 X975 ao
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