1984, 04-19 Permit: 84A-3546 SidingPLAN 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.
2.
STRE ADDRESS
9 305 B )Y1c:
PARCEL NO.
LOT
BLOCK
SUBDIVISION
3
OWN R
aAri F. ><4l!e4n
PHONE
Cfd('` 2651
PHONE
MAILING ADDRESS
ZP
LEGAL DESCRIPTION:
Actual Set Backs in Feet to:
North I South East I West
CONTRACTOR
4. M t, J -u- f3-rL tker
ADD SS
3100 biT9 on n► Road
DESIGNER
5.
LIC SEE)(PIRES
517
P ONE
Size of Parcel I Zone Classification
Residential ❑
Commercial ❑
ZIP
C qc
Type Const.
Occupancy
Sprinklered
❑Yes ❑No ❑ Req 'd.
PHONE
New Const. Valuation
Remodeled Valuation
Total Bldg. Floor Area
ADDRESS
ZIP
Main Floor
Upper Floors
Garage/Storage
Greenhouse
CHANGE OF USE FROM
6.
TO
Cover Deck
Uncv. Deck
Fin. Basement
Unfin. Basement
TYPE ❑ NEW ❑ ALT. ❑ AD' N. ❑ RPL. ❑ MVE.
7.WORK ❑BLD. ❑ PLMB. ❑ MECH. El M.H. ❑POOL
OF OTHER
No. Baths
No. Floors
No. Fin. Rooms
No. Dwellings
Certif1. of Exempt.
or Variance
Required Yes❑ No❑
Received Yes No❑
Number
8.
DESCRIBE WORK
t $i(ti A &D -Fp`:
WATER
PUBLIC ❑
PRIVATE ❑
VALUATION
9. 53q/U
SOURCE
OF
UTILITIES
GAS ' I ELECTRIC
Shorelines/Flood Hazard Plans Required 0
Yes Not Applic. ❑
Received ❑
SEWAGE
SEPTIC ❑
SEWER ❑
Ownership
Public 0 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�4IDE FOR REQUIRED INSPECTIONS
SIGNATURE OF �/ Z-----; ��7 APPLICATION /7s--
OWNER OR AGENT +r '_ DATE
SPECIAL APPROVALS SPECIAL CONDIT • NS: ( E REVERSE SIDE FOR NOTICE)
PRELIM. FINAL DATE
Env. Health
Planning
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
FEES COLLECTED
Building
Plumbing
Mech.
Plan Check
SEPA
Modular/
MFG. Horne
Other (Specify)
TOTAL $ ‘')0
PERMIT NUMBER.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATEISSUEJ 9 -8 4
PERMI1N.4. 6 z
* 6 8.0 O 'i.:34 -AL.