1984, 03-29 Permit: 84A-2734 MHrL,r+ry NUMDCn 4 Ar -M_ IV -14 / f• LKM I I ♦ PERMIT NUMBER
SPOKANE COUNTY — DEPARTMENT OF BUILDING & SAFETY
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
STR ETADDRESS PARCEL NO.
1 is 4017
LOT BLOCK SUBDIVISION/ LEGAL DESCRIPTION:
2. � l6�iDIJ V 4�1'fc �
OWNER� PHONE _ � PHONE /
3. J b- 1321
ADDRESS% Z Actual Set s n Feet to:
400 � ! V �, 0 North 10 South East'30 West
COLICENSE EXPIRES PH NE Size of�cel i Zone Classif cation Residential
NTR
4. ttt7J7J Commercial ❑
ADDRESS ZIP Type Const. Occupancy sprinklered
Dyes ❑No ❑Req'd.
DESIGNER PHONE New Const. Valuation Remodeled Valuation Total Bldg. Floor area r- h
5. ADDRESS ZIP Main Floor per Floors GaragelStorage Greenhouse
6. CHANGE OF USE FROM TO Cover Deck Uncv. Deck I Fin. Basement Unf in. Basement
No. Baths No. Floors No. Fin. Rooms No. Dwellings
TYPE NEW ❑ ALT. ❑ AD'N. ❑ RPL. ❑ MVE.
7. OF❑ OTHER -
WORK ❑ BLD. ElPLMB. ElMECH. `M. H. ❑ POOL Certifi.ofExempt. Required Yes❑ No❑ Number
or Variance Received Yes❑ No❑
DESCRIBEWORK Shorelines/ Flood Hazard Plans Required
8' I'A ?7 el L-i't (� yes Not Applic. ❑ Received ❑
VALUATION I SOOURCE GAS ELECTR pUBLICR T_ SEPTIC E Ownership FEES COLLECTED
9• UTILITIES I I PRIVATE ❑ SEWER ❑ Public ❑ Private el
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
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 REVERS IDE OR REOUIR68, INSPECTIONS Plumbing
SIGNATUOWNER ORR AGENTS DATEE OF Mach.
Mech.
SPECIAL APPROVALS SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PRELIM. FINAL DATE
Env. Health
Planning
Fire
Prevent.
4%p_
Utilities
Plans
Exam.
Building
Tech.
PERMIT IS NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
Plan Check
SEPA
Modular/
�y
MFG. Home
RC1•
Other (Specify)
`
TOTAL $�
WHEN MACHINE VALIDATED IN
THIS BECOMES A PERMIT.
DATEYSSUEC�- " PERMITI' 3• `t 6 * 5 Q. 0 0 ROIPAL
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