1996, 09-17 Permit App: 96007801 Change of Occupancymcn
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APPLICATION INFORMATION
'What is the JOB SITE address?
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ASSESSOR'S tax parcel number?
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Legal description as it appears on the property deed
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OWNER or OCCUPANT/
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Phone
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Mailing address
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City, state Zip
576464oj£ k✓4 9 92/
Who should we contact regarding this project?
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Phone
92-V 57 72
What work is being done under this permit?
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Inspector,distnct
Property size -, -
Right of way width
Water district
Building:. --
Building height
#of stories
Contractor
Dimensions
TOTAL SQUARE FOOTAGE
WA State Contractor license #
Main floor area
Unfinished basement area
Mailing address
2nd floor area
Finished basement area
Architect/Engineer
Garage area
Size of decks, etc.
What is the heat source?
What is the cost of your project?
Manufactured -Home ' -
Sign ..
Width:
Length:
What is the square footage of
the sign face?
How high is the sign?
Year:
Make:
Installer
Contractor
Wa State Contractor license #
Wa State Contractor license #
Mailing address
Mailing address
Relocation
Fire::Safety - _
Previous address
Fire Spnnkler Tent
_ _
Paint booth _ Fire Alarrn _ Fireworks display
VALUE
Contractor
Contractor
WA State Contractor license #
WA State Contractor license #
Mailing address
Mailing address
Fuel,Storage Tanks
Swimming Pool --- - .. • -
(Circle one) Above -ground Underground
Size / gallons
Private
Contents of tank(s)
Size / gallons
Public/semi-private
Contractor
Contractor
Wa State Contractor license #
WA State Contractor license #
Mailing address
Mailing address
COMPLETE ALL APPLICABLE INFORMATION
Spokane County does not discriminate on the basis of disability in the admission to, or treatment or employment in, its programs or activities.
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PROJECT NUMBER= 96007801
APPLICATION DATE= 09/17/96 PAGE= 01
****** THIS IS NOT A PERMIT ******
PENALTIES WILL BE ASSESSED FOR COMMENCING WORK WITHOUT A PERMIT
SITE STREET= 1722 S BLAKE RD
ADDRESS= SPOKANE WA 99206
PERMIT USE=
PLAT#=
BLOCK=
AREA=
# OF BLDGS=
OWNER=
STREET=
ADDRESS=
CHANGE OF OCCUPANCY
001841 PLAT NAME=
1 LOT=
00000000 F/A=
# DWELLINGS=
HAYNES, RON
1722 S BLAKE RD
SPOKANE WA 99206
PARCEL#= 45271.1507
R-3 TO LC FACILITY FOR 6 CLIENTS
OPPORTUNITY TERRACE
7 ZONE= UR -3.5 DIST#=
F WIDTH= 94 DEPTH=
1 WATER DIST =
F
140 R/W=
PHONE= 509 922 1742
CONTACT NAME= RON HAYNES PHONE NUMBER= 509 922 1742
BUILDING SETBACKS: FRONT= EXIS LEFT= EXIS RIGHT= EXIS REAR= EXIS
******************************* BUILDING PERMIT ****************************+*+
CONTRACTOR= OWNER
NEW=
DWELL UNITS=
BLDG W X D =
REQ PARKING=
REMODEL=
OCCUP. LD=
X SQ FT=
#HANDICAP=
DESCRIPTION GROUP TYPE
C OF USE LC VN
ITEM DESCRIPTION
STATE SURCHARGE
CHANGE OF USE/SAFETY INSP
PERMIT TYPE FEE AMOUNT
BUILDING PERMIT 54.50
54.50
PROCESSED BY: BURRIS, ROBIN
PRINTED BY: BURRIS, ROBIN
********************************
PHONE=
ADDITION= CHANGE OF USE= X
BLDG HGT= STORIES=
SPRINKLER= N
CRITICAL MAT= N
SQ FT VALUATION
.00
QUANTITY FEE AMOUNT
Y
Y
4.50
50.00
AMOUNT PAID AMOUNT OWING
.00 54.50
THANK YOU
.00 54.50
************************************
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GENC EGRE'S REOUIRMENTS
R OPENING 1 - i? SQUARE FEET
OPENING HEIGHT- 24 INCHES i
R OPENING WIDTH - 20 INCHES !
SILL HEIGHT • 43 '$C- ES ABOVE
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