1984, 03-23 Permit: 84A-2528 DuplexPLAN NUMBER APPL ICAT ION / PERMIT PERMIT NUMBER
SPOKANE COUNTY — DEPARTMENT OF BUILDING & RAFETY � 7-e
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES -PRESS HARD TO MAKE 3 COPIES
STREET ADDRESS PARCEL NO.
1 5,3Z v 2 �a (l. i.l C;r. 5 y 2- I I �D
LOT
SUBDIVISION
LEGAL DESCRIPTION:
2. i o
2
O N R
PHONE
PHONE
617_K9
3.
bo
MA ING ADDRESS
Actual Set Backs in Feet to:
/��y/ ,�
12.
q Z0a
t F
t I -3Q t
tNF,—
North Z& South CY% East ;/I West
CONTRACTOR c^
S "
LICENSE EXPIRES
PHONEParcel
f I
ZoneClassificaion
Residential
—
4.
5`Sizey�f
(
.�t
,
Commercial
ADDRESS
ZIP
Type Ponqt.
Occupant
Sprinklered
❑Yes ❑No ❑Req'd.
..
DESIGNER
PHONE
Const. Valgation
Remodeled Valuation
Total Bldg. Floor Area
SC�IZ 'P—'
5.
ADDRESS
ZIP
n Flpoor v f Upper
Floors
Gariel$toragep t
Greenhouse
CHANGE OF USE FROM
TO
Cover Deck
Uncv. Deck Fin. j3aWmentsement
B.
Sa
TYPE NEW ❑ ALT. ❑ AD'N. ❑ RPL. ❑ MVE.4.'
No. Baths No.
Floors
No. Fin. Rooms
No. Dwellings
•?
7. OF ❑OTHER
Certif Lof Exempt.
Required Yes❑ No❑
Number
WORK )(,BLD. E3PLMB. ❑ MECH. ❑ M.H. El POOL
or Variance
Received Yes❑ No F-1
DESCRIBE WORK pp» n. } A rte/ / �,,� /�
8. � 9117 0 ciff'� OE
Shorelines/ Flood Hazard
Plans Required
%, P� V)`i/�
Yes Not Applic. ❑
Received
VALUATION I
9
SOURCE
GAS
ELECTRIC
PUBLIC
SEPTIC SEWAGE
Ownership
FEES COLLECTED
UTILITIES
PRIVAT
SEWERJK
Public ❑ 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-
Building
thority to violate or cancel the provisions of any other state or local law regulating construction or the performance
of construction. SEE REVERSES E FOR REQUIRED INSPECTIONS
Plumbing
SIGNATURE OFA PPLICAT ION
.U/eOWNER OR AGENTC:�DATE
Mach.
SPECIAL APPROVALS
SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PRELIM. FINAL DATE
Plan Check
Env. Health
Ii t
tV
SEPA
Planning
Modular/
MFG.Home
Prevent.
Engineer
Utilities
.SEPA
erPERMIT IS NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
Building
Tmh IN 180 DAYS
Other (Specify)
TOTAL $ 6
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES App PERMIT. l pp 8 nn
DATEQJ,ui� 5 — 'J n. PERMI) 2�. , 0 * 4 8 4, 0 J #0-j
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