1984, 03-09 Permit: 84A-2053 CarportPLAN NUMBER
APPLICATION/PERMIT
SPO:ANE COUNTY — DEPARTMENT OF BUIL. 3 & SAFETY
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
STREET ADDRESS
1. 1� .411A061 C:p IV tet. Iti
PARCEL NO.
fold43`-c44-7
LOT
2. 1'7
BLOCK
SUBDIVISION
LEGAL DESCRIPTION:
ill► raf"cr�44714
OWNER
3. rt *1\i t1
MAILING ADDRESS
PHONE PHONE
,0a Cbtiic,c..cIti
4.
CONTRACTOR
cYVL V
ADDRESS
L�►-1 Y�YI�
LICENSE EXPIRES
5.
DESIGNER
ADDRESS
6. CHANGE OF USE FROM
ZIP
PHONE
ZIP
PHONE
ZIP
TO
TYPE ❑ NEW ❑ ALT. VAD' N. ❑ RPL. ❑ MVE.
7. OF ❑ OTHER
WORK L BLD. ❑ PLMB. ElMECH. ElM.H. ❑ POOL
Actual Set Backs in Feet to:
North
1 South LEast I West
Zone Classification
Size of Parcel
-(b X t"? -4 -
Type Const.
Occupancy
Residential
Commercial ❑
Sprinklered
❑Yes ❑No Req Id.
Npv Const. Valuation
I S3
Main Floor
Cover Deck
Remodeled Valuation 1 Total Bldg. Floor Area
Greenhouse
Upper Floors
Uncv. Deck
Garage/Storage
J �
Fin. Basement
Unfin. Basement
No. Baths
No. Floors
No. Fin. Rooms
Certifi. of Exempt.
or Variance
Required Yes❑
Received Yes
Noll/
No❑
No. Dwellings
Number
DESCRIBE WORK
8" (.._utZPota,_
- VALUATION
9.,
SOURCE
OF
UTILITIES
GAS
ELECTRIC
Shorelines/Flood Hazard
Yes NotApplic. ❑
WATER
PUBLIC ❑
PRIVATE ❑
SEWAGE
SEPTIC ❑
SEWER ❑
Ownership
Public ❑ Private 0
thereby certify that 1 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 -.---1-41/1
/j2yln-.�
DATECATION 3 t _ b
SPECIAL APPROVALS
PRELIM. FINAL DATE
Env. Health
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
yDoG No Ic E G -r .ez?'r tc C QED_ A-YA)t20%,rO
'Ii -C. ''CC RAN)
ScAZacc-7 Z"b Owc` c 1Nt cTIoN
PERMIT IS NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
Plans Required 0
Received ❑
FEES COLLECTED
Building
Plumbing
Mech.
Plan Check
SEPA
Modular/
MFG. Home
Other (Specify)
3), YC•
TOTAL $ 32 ` E
PERMIT NUMBER
—2
62* *3200
*32.006
*0,30
205,2
03-C9-84
6479,
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATEOSJE� 7 — 8 Q
PERMIT O.,-"• z
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