1984, 01-13 Permit: 84A-369 InsertPLAN 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
ST EET ADDRESS
1 • �9.20A �/4-/a/JD
PARCEL NO.
LOT
2.
BLOCK
SUBDIVISION
3 Gr, u
PHONE
gay L5sot
PHONE
LEGAL DESCRIPTION:
AILING ADDRESS
9a a.2
ZIP
Actual Set Backs In Feet to:
North (South East [ West
4.
C� RACTOR /J 1
LICEfJS�xPIRES
PH NE
' x7/72
Size of Parcel 1 Zone Classification
Residential 0
Commercial 0
t?ta 7
Z 9ae7
Type Const.
Occupancy
Spr'nklered
❑Yes 0No ❑Raged.
DESIGNER
5.
ADDRESS
PHONE
New Const. Valuation
Remodeled Valuation
Total Bldg. Floor Area
ZIP
Main Floor
Upper Floors
Garage/Storage
Greenhouse
6.
CHANGE OF USE FROM
TO
Cover Deck
Uncv. Deck
Fin. Basement
UnfIn. Basement
TYPE 0 NEW
7. OF
WORK 0 BLD.
❑ ALT. 0 AD' N. 0 RPL. 0 MVE.
❑ PLMB. 0 MECH. 0 M.H. 0 POOL
•
tA9
aDESCPIBE,y/54terrx.) n ,
VALUATION
9.
SOURCE
UTILF
ITIES
GAS
ELECTRIC
0 OTHER
WATEq
PUBLIC
PRIVATE 0
SEWAGE
SEPTIC 0
SEWER 0
No. Baths
No. Floors
No. Fin. Rooms
No. Dwellings
Garth. of Exempt.
or Variance
Shorelines/Flood Hazard
Yes0 Not Applic.0
Ownership
Public 0 Private 0
Required Yes LI No❑
Received Yes No0
I hereby certify that I have read and examined thls application and have read the "NOTICE" provisions included on
reverse side, and I;gow 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 'al RSE SIDE FOR REQUIRED INSPECTIONS
SIGNATURE OF Mt OWNER OR GENT A, �'� DATEICATION 1/AAPPLper/
SPECIAL APPRO 45rLS
J Y'
PRELIM. FINAL DATE
Env. Health
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)/
e t CF-
cam /"�-�D�.M-1 'per
PERMIT IS NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
Number
Plans Req Iced 0
Received 0
FEES COLLECTED
Building
Plumbing
Mech.
Plan Check
SEPA
Modular/
MFG. Home
Other (Specify)
TOTAL $Qe/
PERMIT NUMBER
OciA %q
04* *2000
*2000'6
A *0.00 8
368
0.1-13-84
2 6479.
Y
O
V
W
—J
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMESA PERMIT.
DATEQ7 i�Jr7Y J nJ w
SSUEDL .8 4'
:
PERMIT N9'6 9 ,z
*,2.0.0 0.1PFJAL