1984, 02-08 Permit: 84A-1308 ResidenceNumber
PLAN NUMBER
STREET ADDRESS
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. .43Q? _ Dt 4
LOT I BLOCK I SUBDIVISION
2. S i—C�{k' i 1MFAOC>i.c..�j
OWNER
3. %Att�`'Cr •��'v i� i I♦V f
MAILING ADDRESS
1_.I ,v S
CONTRACTOR
4.'��"'«
ADDRESS
a V q
PHONE
LICENSE EXPIRES
DESIGNER
5. ADDRESS
CHANGE OF USE FROM
TO
PHONE
ZIP
PHONE
ZIP
PHONE
ZIP
PARCEL NO.
�7tly c5
LEGAL DESCRIPTION:
Actual Set Backs in Feet to:
North I fES 'South t East
Size of Parcel
(-'zC6.LAC-4(4 f2
Type Const. Occupancy
R-3( nom— I
New Const. Valuation
TYPE 0 NEW ❑ ALT. ❑ AD' N. ❑ RPL. ❑ MVE.
7. OF❑ OTHER
WORK BLD. ❑ PLMB. ❑ MECH. ❑ M.H. ❑ POOL
SCRIBE WORK
8. '
West
Zone Classification
-1
Residential p"
Commercial 0
Spr'nklered
❑Yes ❑No ❑Req'd.
Remodeled Valuation
Main Floor Upper Floors
I3�3
Cover Deck
No. Baths
Certif1. of Exempt.
or Variance
Total Bldg. Floor Area
Garage/Storage
c
VALUATION
9.
SOURCE
F
UTILITIES
GAS
ELECTRIC
WATE1117
PUBLIC
PRIVATE ❑
SEWAG
SEPTIC ■
SEWER 0
Greenhouse
Fin.
Basement
C., (4
No. Fin. Rooms
S
Required Yes Nom
Received Yes Non
Shorelines/Flood Hazard
Yes Not Applic. ❑
Ownership /
Public 0 Private [3'
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 IDE FO , E IRED INSPECTIONS
SIGNATURE OF
OWNER OR AGENT
SPECIAL APPROVALS
ELIM. FINAL DATE
Env. Healt
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
APPLICATION
DATE
SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PERMIT IS NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
Unfin. Basement
No. Dwellings
Plans Required
Received
FEES COLLECTED
Building
Plumbing
Mech.
Plan Check
SEPA
Modular/
MFG. Home
Other (Specify)
TOTAL $ 38. c�
PERMIT NUMBER
L* *35800
*358005
A *000 n
130,7�
02 -15 -84-
f
2 -15-84f 6479,
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
02=15=84 130.85 *358.002.
PERMIT NO. ,TOTAL
DATE ISSUED
6
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