1992, 06-04 Permit App: 92004021 AdditionSPOKANE COUNTY DEPARTMENT OF BUILDINGS
W. 1303 BROADWAY AVENUE
SPOKANE, WASHINGTON 99260
(509) 456-3675
I certify that I have examined this permit/application, state that the information contained in it and submitted by me or my agent to compile said permit/application is true
and correct, and authorize Spokane County to proceed with processing. In addition, I have read and understand 'the INSPECTION REQUIREMENTS/NOTICE
provisions included herein and agree to comply with same. All provisions of laws and ordinances governing this type of work will be complied with whether specified
herein or not. I understand that the issuance of this permit/application and any subsequent inspection approvals or Certificates of Occupancy shall not be construed to
give authority to violate or cancel the provisions of any state or local law regulating construction, or as a warranty of conformance with the provisions of any state or local
laws regulating construction.
SIGNATURE OF APPLICATION
OWNER OR AGENT DATE
PROJECT NUMBER,, 5'2004021
APPLICATION
DATE., :.: ;(.4/c:, i Pf
**.*A,* $i,' 4 !" I .L t'd O I A P E R 4"t I. 1 3r * .g. g;. •i,; :,i.
i...l.lt``lI 11'. NC i. Ci;, WORK WITHOUT PFRIT
PENALTIE WILL BE
PERMIT
t O i! i i't' l... WA
RESIDENCE ADDITION _.. BEDROOM Pt`:;T(..1
.: 1 f}1}.Ih.i..i
CONTACT NAME- ;' I:::
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BUILDING ,'> !: 11.:i i-, C I; :' R !'t j •d
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MOUNTAIN L.E I_! i' ::, F'I f. l �aWIDTH., 90 DEPTHWATER
1:
PHONE= 509 97.
SPoKANE
PHONE NUMBER., F;09 92
RIGHT= 50 REAR., NA
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DEPARTMENT
E3 BUILDING
Z.:5 BUILDING
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REVIEW COMMENTS
PLAN !'it:: :i. Eqi REQUIRED
SETBACK REVIEW REQUIRED
INCREASE IN LOT C; O'O::: i '::, t:Y i
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cm0TRACTOR- OWNER
HATTO
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Spokane County
DEPARTMENT OF BUILDING & SAFETY
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675
INFORMATION WORKSHEET
PARCEL NUMBER:
STREET ADDRESS: S • 7 O / G //'4 r.d
CITY/STATE/ZIP: S P Q/cid e. / w A. 9 9.A LA
SUBDIVISION:
BLOCK: LOT: ZONE: DISTRICT: ,%� /
LOT AREA: F/A:
WIDTH: DEPTH:R/W: 7 )
# OF BUILDINGS: # OF DWELLINGS: WATER DISTRICT:
OWNER: e 6-i • Al eis o -)
MAILING ADDRESS: .$'. 70/ 6/. .1+-d
PHONE: - 3 4 9
CITY/STATE/ZIP: .5-10.6AcAdve, . 9 901/ Z
CONTACT:
SETBACKS: - FRONT: LEFT:
PERMIT USE:
PHONE:
GHT: REAR:
**********, *****+ ***** ****, ************** ******, **************************
BUILDING INFORMATION
CONTRACTOR LICENSE NUMBER:
CONTRACTOR:
MAILING ADDRESS:
PHONE:
IMB
ARCHITECT/ENGINEER: PHONE:
MAILING ADDRESS: /
NEW: REMODEL: ADDITION: ✓ CHANGE OF USE:
DWELL UNITS: OCCUPANT LOAD: BUILDING HGT:
STORIES:
BUILDING DIMENSIONS: f 4 X vfiO (WIDTH X DEPTH) SQ. FT.:
REQUIRED PARKING: # HANDICAP: SPRINKLERED: CRITICAL MATERIAL:
Heat. System
1
Use of Bldg.
(run, part, none)
Type of Roofing
Ext. Finish
Garage or Carport Attached Pr]
PLOT PLAN
Draw sketch with dimensions showing: (1) property lines; (2) street or rc
proposed buildings; (4) distance to property lines and streets; (5) dimension
tem and water supply lines.
NORTH
77W AV.E
I hereby certify informatio
SOUTH
mi ted
m
N
there are no othe]
Owner or Agent
A LAND USE OR STRUCTURE PERMIT MUST BE
THIS IS NOT A PERMIT.
c3`ivc, rf
THE PREMISES BEI
DO NOT WRITE BELOW THIS LI
Your street address will be f7.OJ
Sewage Permit Number Issued Building Pe
Remarks
Form 523 Bldg. Code