1984, 04-09 Permit: 84A-3106 Pole BldgArrL 19--oA 1 1 IV / F LKM 1 1
l SPOKAW COUNTY — DEPARTMEENTOF BUILDING & SAFETY
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
STRE ADDRE PARCEL
�e 5 _r�? - 2-4
Loy BLOCK SUBDIVI ION LEGAL DESCRIPTION:
2. ( L
OWN PHONE P ONE
SPECIAL APPROVALS
PRELIM.
`Env. Health
Planning
Prevent.
Utilities
PECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
A-1 "A-, It
I
Plans 47iJPERMIT IS NONTRANSFERABLE
Exam. ' ' L PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
Building
Tech. 4 IN 180 DAYS
Check
SEPA
Modular/
MFG. Home
Other (Specify)
TOTAL $ 47-0
PERMIT NUMBER
i
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATE Iasi F'D a PERMIT I Oj}
5 4• U IJT.gTAL
o_
a
O
V
W
J
LL
MA ING ADDRESS
ZI
Actual Set Backs in Feet to:
North South East
West
RACTOR
LICENSE EXPIRESP
Size Parcel
Zone Classification
Residential ❑
4.
—
-57—%Ze C
Commercial ❑
,,—ADDRESS
71P
Type Const. Occupancy
Sprinklered
❑Yes ❑No ❑Req'd.
DESIGNER
PHONE
Const. Valuation
Remodeled Valuation
Total r Area
Pz�. 4o
5.
ADDRESS
ZIP
Main Floor Upper
FloorsGarage/Storage
Greenhouse
CHANGE OF USE FROM
TO
Cover Deck
Uncv. Deck
in. Basement
Unfin. Basement
W El ALT. ElAD'N. ❑ RPL. ElMVE.
TYPEtBLD.
No. Baths No.
Floors
No. Fin. Rooms
No. Dwellings
7.
❑OTHER
_-
WORK ❑ PLMB. ❑ MECH. ❑ M.H. ❑ POOL
Certifi. of Exempt.
Required
Yes❑ No
lyyWber
or Variance
Received
Yes❑ No❑
8'
RIB ORK ,/
��C �� "
Shorelines/Flood Hazard
Plans Required . /
Yes[] NotApplic. ❑
Received B
9
V LUATION
SOOU�CE
GAS ELECTRIC
pUBLICR❑
SEPTICE
1
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 included on
reverse side, and know the same to be true and correct. All provisions of laws and ordinances governing this type of
Building Occ'
work will be complied with whether specified herein or not. The granting of a permit does not presume to give au-
ICA,
thority to violate or`cance he provisions of any o er state or local law regulating construction or the performance
of construction. SEERIEVJMSE SIDE FOR REQ ED INSPECTIONS
Plumbing
SIGNATURE OF
APPL ICATI�-
OWNER OR AGENT
DATE
Mach.
SPECIAL APPROVALS
PRELIM.
`Env. Health
Planning
Prevent.
Utilities
PECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
A-1 "A-, It
I
Plans 47iJPERMIT IS NONTRANSFERABLE
Exam. ' ' L PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
Building
Tech. 4 IN 180 DAYS
Check
SEPA
Modular/
MFG. Home
Other (Specify)
TOTAL $ 47-0
PERMIT NUMBER
i
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATE Iasi F'D a PERMIT I Oj}
5 4• U IJT.gTAL
o_
a
O
V
W
J
LL