1984, 02-28 Permit: 84A-1672 Basement FinishrLAN NUMtstH ArrL III.:ArIUN / PERM 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
STREET ADDRESS PARCEL NO.
.
113 10 P -Al P„ /JVW
LOT BLOCK SUBDIVISION LEGAL DESCRIPTION:
2. 1Jwtflcl��lPh3 ,fir k
OWNER PHONE PHONE
,7 O
MAILING ADDRES§
ZIP
Actual Set Backs in Feet to:
®
North South East
West
CONTRACTOR �^A
'
LICENSE EXPIRES
PHONE
Size of Parcel
Zone Classification
Residential
4.
Commercial ❑
ADDRESS
ZIP
Type Const.
Occupancy
Sprinklered
Dyes ❑No ❑Req'd.
DESIGNER
PHONE
New Const. Valuation
Remodeled Valuation
Total Bldg. Floor Area
5.
ADDRESS
ZIP
Main Floor Upper
Floors
Garage/Storage
Greenhouse
6. CHANGE OF USE FROM
TO
Cover Deck
Uncv. Deck
Fin. Basement
Unfin. Basement
PE ❑NEW El ALT. El AD'N. 11 RPL. El MVE.
No. Baths No.
Floors
No. Fin. Rooms
No. Dwellings
!• OF OTHER
WORK ElBLD. ElPLMB. 11MECH. ElM.H. ElPOOL
Certifi.ofExempt.
Required
Yes❑ No❑
Number
or Variance
Received
Yes❑ No❑
8. DESCRIBE WORK �^����iN��j�,-� IN�n
pans Required
�❑elinesNoloodplazar❑d
❑
01
9 ZA� ATIONO
SOURCE
OF
GAS
ELECTRIC
PUBLIC ATE ❑
SEPTIC ❑
Ownership
FEES COLLECTED
1
UTILITIES
PRIVATE ❑
SEWER ❑
Public ❑Private ❑
certify that I have read and examined this application and have read the "NOTICE"
provisions includelof
reverse side, and know the same to be true and correct. All provisions of laws and ordinances governing this typwork
will be complied with whether specified herein or not. The granting of a permit does not presume to give
Building
thority to violate or cancel the provisions of any other state or local law regulating construction or the performa
of construction. SEE REVERSE IDE FOR REQUIRED INSPECTIONS
Plumbing
SIGNATURE OF APPLICATION
,
OWNER OR AGENT DATE
Mech.
SPECIAL APPROVALS
SPECIAL CONDITIONS: (SEE ROVERSE SIDE FOR NOTICE)
PRELIM. FINAL DATE
Plan Check
Env. Health
Planning
Prevent
Utilities
SEPA
Plans PERMIT IS NONTRANSFERABLE
Exam. PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
Building IN 180 DAYS
Tech.
SEPA
Modular/
MFG. Home
Other (Specify)
P RMIT NUMBER
A — /,y Z=-
TOTAL $
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATEhSt uFi:2 8 .J 4 PERMITiNe. 7, 2 5
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