1984, 01-19 Permit: 84A-589 AdditionPLAN NUMBER
APPLICATION/PERMIT - S'
SPOKANE COUNTY - DEPARTMENT OF BUILDING & SAFETY
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3875
APPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 3 COPIES
STREET ADDRESS
1. kI 1515
LOT BLOCK
2.L- I
G- 17-A
PARCEL NO.
17 55z — 0 502--
3.
4.
OWNER
SUEDIVISION
IN/1 15'5101\I VISOC i% Avo
PHONE
01E-NIs -1u04-
PHON
MAI ING ADDRS
• I f Ei 1
CONTRAC ,(0
cl�4�W,/r1 t
LEGAL DESCRIPTION:
Actual Set Backs in Feet to:
North 5 ISouth [East I West
LICENSE EXPIRES
PHONE
Sizeof Parcel
Zone Clessl(I
.atlon
ResIdentiaad
Commercial 0
ADDRESS
ZIP
Type Cgnst. I
Oceu
annoy
Spr nklered
❑Yes ❑No
❑ Req' d.
5.
DESIGNER
PHONE
New Cons Valuation
5 0
Remodeled Valuation
Total Bldg Floor Area
ADDRESS
ZIP
Main Floor
300
Upper Floors
Garage/Storage
Greenhouse
CHANGE OF USE FROM
6.
TO
Cover Deaf
Uncv. Deck
Fin. Basement
Unfin. Basement
7.
TYPE ❑ „NEW 0 ALT. Q4'N. 0 RPL.
OF
ALD. 0 PLMB. 0 MECH. 0 M.H
WORK
❑ MVE.
❑ POOL
❑ OTHER
No. Baths
No. Floors
No. Fin. Rooms
No. Dwellings
Certif1. of Exempt.
or Variance
Required Yes❑ No
Received Yes❑ No
DESCRIBE WORK•
8. !Prr
��IJ C7 I
VALUATION
9.
SOURCE
OF —
UTILITIES
GAS
ELECTRIC
WATER
PUBLIC
PRIVATE 0
SEWAG�
SEPTIC YE
SEWER D
Shorelines/Flood Hazard
Yes❑ Not Applic. D
Plans
❑ Number
Required V
Received
Ownership %
Public ❑ Private Q�
1 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
SIDE FOR REQUIRED INSPECTIONS
SIGNATUROWNER ORE GENT '-P -f� lM DATEOF CATION I—,n�– 1/
SPECIAL APPROVALS SPEC AL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PRELIM. FINAL DATE
Env. Health
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
J
V19
PERMIT IS NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
FEES COLLECTED
Building
Plumbing
Mech.
Plan Check
SEPA
Modular/
MFG. Home
Other (Specify)
TOTAL $ t32_
PERMI NUMBER
-5
02* *82.00
5872
0,1-19-84
2 6479
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
4.1i4.II)� eM. , x!. v C, p
DATt'1SjUEjjd 9 8 4 PERMIT N6.8, 9 5 * 8 2 0 0 IWTAL
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