1984, 03-30 Permit: 84A-2770 AdditionPLAN NUMBER
APPLICATI.ON/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 ADDRS
1. S 2
LOT
2.
BLOCK
SUBDIVISION
OWNER
3.=
MAILING ADDRESS
PHONE
COI�F�4liTQR
4. ADDRESS
LICENSE EXPIRES
PHONE
' e"7-)3,421
PHONE
PARCEL NO.
'5a -
LEGAL DESCRIPTION:
Actual Set Backs in Feet to:
North 'South
East
West b
Size of Parcel 1 Zoe �CI fication
122). l'-'
Qssi
Residential ❑
Commercial ❑
ZIP
Type Qon�t.
Occupancy
Sprinklered
❑Yes ❑No Req 'd.
DESIGNER
5. ADDRESS
PHONE
ZIP
CHANGE OF USE FROM
6.
TO
New Const. Valuation
Malg67
Cover Deck
Remode ed Valuation
Total Bldg. Floor Area
Upper Floors
Garage/Storage
Greenhouse
Uncv. Deck
Fin. Basement
Unfin. Basement
TYPE ❑ yEW ❑ ALT.D' N. ❑ RPL. ❑ MVE.
7 OF WORK BLD. ❑ PLMB. ❑ MECH. ❑ M.H. 10POOL ❑ OTHER
No. Baths
No. Floors
No. Fin. Rooms
No. Dwellings
Certifi. of Exempt.
or Variance
Required Vest: No
Received Yes❑ No❑
Number
DESCRIBE WORK
8. I`v�- A-90 Ito
VALUATION SOURCEOELECTRIC
UTILITIES
9.
GAS
Shorelines/Flood Hazard
Yes El NotApplic. ❑
Plans Required/
Receiv
PUBLIC RAd
PRIVATE ❑
SEWAGE
SEPTIC
SEWS ❑
Ownership
Public ❑ Private.V
1
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 SIDE FOR REQUIRED INSPECTIONS
OGNATURE rjF 4��
OWNER OR AGENT
SPECIAL APPROVALS
PRELIM. FINAL DATE
Env. Health
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
Jew
3/3
0
APPLICATION 3
DATE
SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
7
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 $
PERMIT NUMBER
o4 - 27'70
L
li 7
u
coy
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATEISUEDD O 8 4
PERMI12b.7, a z
*9600 rdTAL