1984, 02-17 Permit: 84A-1368 AdditionOwnership
Public 0 Private
PLAN 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
PARCEL NO.
2'754(-32o
LOT
2. t
BLOCK SUBDIVISION
tsDD i T Or'
OWNER
3 ,-.3oNN F\u►UE
MAILING ADDRESS
PHONE
PHONE
C 1444 "
LEGAL DESCRIPTION:
na2— '-DAL7 cj
4.
CONTRACTOR
ADDRESS
LICENSE EXPIRES
DESIGNER
5.
ADDRESS
CHANGE OF USE FROM
ZIP
PHONE
ZIP
PHONE
ZIP
TO
TYPE ❑ W ❑ ALT. tIZAD' N. ❑ RPL. ❑ MVE.
7. OF WORK " BLD. D PLMB. ❑ MECH. D M.H. ❑ POOL ❑OTHER
Actual Set Backs in Feet to:
North
( South [East I West E50.
Size of Parcel
" A LS?,
Zone Classification
Type Const.
1V
Occupancy
V
Residential lit'
Commercial ❑
Sprinklered
❑Yes ❑No ❑Req'd.
ew Const. Valuation I Remodeled Valuation Total Bldg. Floor Area
2.,"Tri i o4.
Main Floor
104
Cover Deck
No. Baths
Certif1. of Exempt.
or Variance
Upper Floors
Garage/Storage
Greenhouse
Uncv. Deck
Fin. Basement
Unfin. Basement
No. Floors
No. Fin. Rooms
No. Dwellings
Required Yes❑ No
Received Yes No❑
Number
DESCRIBE WORK
8. -AD tTt(5ri RL :' tP CX -
VALUATION
9.
SOURCE
F
UTILITIES
GAS
ELECTRIC
Q>
WATER/ SEWAGE/
PUBLIC SEPTIC
PRIVATE ❑ SEWER ❑
Shorelines/Flood Hazard
Yes❑ Not Applic. ❑
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 SI • E F • R REQUIRED INSPECTIONS
SIGNATURE OF
OWNER OR AGENT
SPECIAL APPRO
PRELIM. FINAL
DATE
Env. Health
2
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
2//7
Building
Tech.
77
APPLICATION / 7
DATE
SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PERMIT IS NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
Plans Required
Received
FEES COLLECTED
Building CYr1
Plumbing
Mech.
Plan Check
SEPA
Modular/
MFG. Home
Other (Specify)
TOTAL $` 7 Ca,
PERMIT NUMBER
4A
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATE'2UEDl 7 — 8 4
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