1984, 03-27 Permit: 84A-2613 ResidencePLAN NUMBER APPLIICATION /PERMIT
ON SPOKANE COUNTY — DaA' ARTMENT 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.
1. 1124 %>
101,543 -0
LOT
BLOCK
SUBDIVISION
LEGAL DESCRIPTION:
Ado
I
TYPE NEW ❑ ALT. ❑ AD'N. ❑ RPL. ❑ MVE.
OWNER
PHONE
PHONE
3 �t E�t.w.tivo �e 6A
7. ❑OTHER
❑
Z'JC 2 _ 1,10`)
MAILING ADDRESS
ZIP
Actual Set Backs in Feet to:
C --Z " k -75 \
Required Yes❑ No
North t (V South' East '3t� I West
CONTRACTOR
LICENSE EXPIRES
PHONE
Size of Parcel
Zone Classification
Residential
4.
8 DESCRIBE WORK
Shorelines/ Flood Hazard
1 1C')( 14{ 0
� i 0C(%CZ
Commercial ❑
ADDRESS
ZIP
TyDge Const.
Occupancy
Sprinklered
..(
SEWAGE
Ownership
Q
❑Yes ❑No ❑Req'd.
DESIGNER
PHONEConst.
N Valuation
Remodeled Valuation
Total Bldg. Floor Area
5.
Public ❑ Private
!6(o. 2sb
ADDRESS
ZIP
Main Floor
Upper Floors
Garage/Storage
Greenhouse
to violate or cancel the provisions of any other state or local law regulating construction or the peof
construction. SEE REV RSE SIDE FOR REO RED INSPECTIONS
Plumbing
PERMIT NUMBER
4- �I>
CHANGE OF USE FROM
TO
Cover Deck
Uncv. Deck Fin. Basement
Unfin. Basement
6.
Ado
TYPE NEW ❑ ALT. ❑ AD'N. ❑ RPL. ❑ MVE.
No. Baths No.
Floors
iJC
No. Fin. Rooms
No. Dwellings
1
7. ❑OTHER
❑
Certifi of Exempt.
Required Yes❑ No
Number
WORK 2(BLD. PLMB. ❑ MECH. ElM.H. ❑ POOL
or Variance
Received Yes[--] No❑
IT
8 DESCRIBE WORK
Shorelines/ Flood Hazard
Plans Required
� i 0C(%CZ
Yes Not Applic. ❑
Received
VALUATION I SOURCE
9•
GAS
ELECTRIC
PUBLIC
SEWAGE
Ownership
FEES COLLECTED
UTILITIES
PRIVATE ❑
SEWER ❑
Public ❑ Private
I hereby certify that I have read and examined this application and have read the "NOTICE" provisions in]edn
reverse side, and know the same to be true and correct. All provisions of laws and ordinances governing tBuilding
work will be complied wit
h whether specified herein or not. The granting of a permit does not presume tthority
to violate or cancel the provisions of any other state or local law regulating construction or the peof
construction. SEE REV RSE SIDE FOR REO RED INSPECTIONS
Plumbing
SIGNATURE OF i APPLICATIONOWNER OR AGENT DATE �� /9 -
Mach.
SPECIAL APPROVALS
S CIAL CON)))DITIONS: (SEvE REVERSE SIDE FOR NOTICE)
PRELIM. FINAL
DATEal
Plan Check
Env. Health
I
�•
'3
J .
SEPA
Planning
Modular/
MFG. Home
>
Fire
Prevent.
In
C
n //
`1-1
4
Other (Specify)
C.
Engineer
U
Utilities
TOTAL $ 6�
SEPA
PERMIT IS NONTRANSFERABLE
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
Plans
Exam.
/
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
1N 180 DAYS
r 3- 2 7!�� 1, 3* 3 5 x 0 0 -'
BuildTech.�ng
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1-1
DATE ISSUED PERMI 9fdTAL
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