1984, 03-01 Permit: 6479 AdditionMLAM NUmtstH ( ArrL11.:A I KJN/ F LKM IT
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 STREET ADDRESS� PARCEL NO. � O O
LOT BLOCK SUBDIV SIONis � LEGAL DESCRIPTION:
2. � . r��� � R:IZ. •-I'rL
N ' PHONE r2 PHONE
3. '
MAI ING A PDR06
Actual Set Backs in Feet to:
10 1
North South East West
CONTRq/�}
��
LICENSE EXPIRES
PHONE
Size of Parcel ZaCl
�-
Ifi on
imercial
`
4.
❑
ADDRESS
ZIP
Type stJ Occupancy
Sprinklered
i
Dyes ❑No ❑Rsq'd.
DESIGNER
PHONE
New Cpnst. atlon _
I
Remodeled Valuation
Total Bldg. Floor Area
-!
ADDRESS
ZIP
Main F9pr� Upp�,
tDock
go� Garage/Storage
Greenhouse
CHANGE OF USE FROM
TO
Cover
Uncv. Deck
Fin. Basement
Unfin. Basement
6.
-
TYPE �AD'N.
No. Baths No.
Floors
No. Fin. Rooms
No. Dwellings
7 OF ❑NEW ❑ALT. ❑RPL. ❑ MVE. ❑OTHER
WORK BLD. ❑ PLMB. ❑ MECH. ❑ M.H. ❑ POOL
Certifl.ofExempt.
Required Yes No❑
Number
or Variance
Received Yea ❑ No ❑
DESCRIBE WOR
8' �6 �I �'
Shorelines/ Flood Hazard
Plans Required ❑
Yes❑ Not Applic. ❑
Received ❑
VALUAT((plN
9 00
I SOOUFCE
GAS
ELECTRIC
PUBLIC R�
SEPTIC
Ownership
Public
FEES COLLECTED
UTILITIES
PRIVATE
SEWERE
❑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. SEE REVERSE SIDE FOR REQUIRED INSPECTIONS
Plumbing
SIGNATURE OF APPLICATION/
W4
W
OWNER OR AGENT DATE
�-� r
Mach.
SPECIAL APPROVI
PRELIM. FINAL
Env. Health L� M
Planning M
Prevent
Engineer
Utilities
SEPA
Plans
Exam.
5 SPECIAL
CO ONS: (SEE
SEE REVERSESSIDE FOR NOTICE)
)ATE 1�0VIIIV F.3jiU S7v (ettq
LbJ3 i��r
PERMIT IS NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
Plan Check
SEPA
Modular/
MFG. Home
Other (Specify)
PERMIT NUMBER
TOTAL $
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATE ISSUED PERMIT NO. TOTAL
d
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Cj
W
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