1984, 04-05 Permit: 84A-3024 GaragePLAN 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
STREET ADDRESS
LOT BLOCK
2. k 'Z.
OWNER
3 E ise\ . �c- A
SUBDIVISION
'm I D
PHONE
PHONE
MAILING ADDRESS ZIP
CONTRACTOR
4.
ADDRESS
LICENSE EXPIRES
DESIGNER
5.
ADDRESS
CHANGE OF USE FROM
PHONE
ZIP
PHONE
ZIP
TO
TYPE iNEW ❑ ALT. ❑ AD' N. ❑ RPL. ❑ MVE.
7. OF IBLD. ❑ PLMB. ❑ MECH. ❑ M.H. ❑ POOL
WORK
❑ OTHER
PARCEL NO.
LEGAL DESCRIPTION:
Actual Set Backs in Feet to:
North VG. t [South
East I West
Size of Parcel
Type nst. Occupancy
Cv ivy_
Main Floor
Zone Classification
Residential 19'
Commercial ❑
Spr'nkiered
❑Yes ❑No ❑Req'd.
Remodeled Valuation
Upper Floors
Cover Deck
No. Baths
Certifi. of Exempt.
or Variance
Garage/Storage
No. Floors
DESCRIBE WORK
VALUATION
9.
SOURCE
F
UTILITIES
GAS
ELECTRIC
WATER SEWA
PUBLIC ❑ SEPTI
PRIVATE ❑ SEWER ❑
Total Bldg. Floor Area
+3
Greenhouse
Fin. Basement
No. Fin. Rooms
Required Yes❑ Nod -
Received Yes ❑ No Cl
Shorelines/Flood Hazard
Unfin. Basement
No. Dwellings
Number
i-.
Plans Required-'
Yes❑ Not Applic. ❑ Received ❑
Ownership
Public ❑ 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. SE - REV SE S1
i
SIGNATURE OF
OWNER OR AGEN
OR REQUIRED INSPECTIONS
SPECIAL APPROVALS
PRELIM. FINAL DATE
Env. Heat
Ecus 4/4.
Planning
Fire
Prevent.
Engineer
4/4
Utilities
SEPA
Plans
Exam.
Building
Tech.
APPLICATIO
DATE
S CIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
6
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. Home
Other (Specify)
TOTAL $54+ s
PERMIT NUMBER
- 24-
02* *`400
*; 4.00
*000
3 0 2. 1
04-0`•-84
6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATE1l� 5 8 4
—
PERMIT5/14. 2 4 z
*54•00fo1AL