1984, 01-31 Permit: 84A-860 Fire Damage RepairPLAN NUMBER APPL ICAT ION /PERMIT
SPOKANE COUNTY - DEPARTMENT OF BUILDING & SAFETY
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
1_
2.
3.
NG ADDRESS
4. I -J -:
ADDRESS
5.
ADDRESS
APPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 3 COPIES
)o4 as PARCEL NO. Z 0-73
i
SUBDIVISION LEGAL DESCRIPTION:
PHONE PHONE Ynmdb�<;Vjb '�)�� tv
s osS. sia
»» rQ 1' n l,+r
ZIP Actualt Bac n Feet to:
n V i LA N& North I South I East I West
LICENSE EXPIRES
nt _une,.,assmcauon Residential ❑
j commercial ❑
Type Const. Occupancy Sprinklered
t ❑Yes ❑No ❑Req'd.
NE New Const. Valuation I Remodeled Valuation I Total BldQ. Floor Area
ZIP I Main Floor I Upper
CHANGE OF USE FROM TO Cover Deck Uncv. Deck in. Basement Unfin. Basement
s. i'
No. Baths No. Floors No. Fin. Rooms No. Dwellings
7. TOFPE NEW ❑ALT. El AD'N. ❑RPL. 1:1 MVE. ❑ OTHER
WORK )MBLD. ❑ PLMB. ❑ MECH. ❑ M.H. ❑ POOL
Certifi.ofExempt .
Required Yes❑ No❑
Number
or Variance
Received Yes❑ No❑
DESCRIBE WORK„ �► n ,, ^ A -� /„AW
8. i(
Shorelines/Flood Hazard
Plans Required ❑
�(�/i
Yes❑ Not Applic. ❑
Received ❑
VALUATION
4'0,00 0-0,
SOURCE
GAS
ELECTRIC
WATER
❑
SEWAGE I
SEPTIC ❑
Ownership
FEES COLLECTED
UTI___T
LITIES
ElPUBLIC
PRIVATE
SEWER ❑
public ❑Private ❑
Ill
hereby certify that I have read and examined this application and have read the "NOTICE” provisions included on
side, and know the same to be true and correct. All provisions of laws and ordinances governing this type of
1-010reverse
Building "Zol "�
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 YNSPECTIONS
Plumbing
SIGNATURE OF APPLICATION
OWNER OR AGENT '� —� DATE �_ �" ,L
Mech.
SPECIAL
APPROVALS
SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PRELIM.
FINAL DATE
LI C , ,� N(J(Z.�'I-� 12-0 37 1
r
Plan Check
Env. Health
SEPA
Planning
Modular/
MFG. Home
Fire
Prevent.
Other (Specify)
i?
Engineer
Utilities
TOTAL $
SEPA
PERMIT IS NONTRANSFERABLE
WHEN MACHINE VALIDAT
THIS BECOMES A PERMIT.
Plans
Exam.
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
n 1 E 1 F'r 3 j _� ' T
DATEYOU D/ /
Building
Tech.
PERMIT NUMBER
F/01)
IN THIS SPACE,
PERMIT Nk& 0 z * 2 0, 0 0 m}AL
O
C
C
u
U