1984, 04-17 Permit: 84A-3415 MHFLANNUMl:Sttt �►rr�I �►I IVI I/VILKIYIII % PERMITNUMBER
SPOKANISCOUNTY - DEPARTMENT OF BUILDING & SAFETY '0
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 3 COPIES
ST EET DRESS PARCEL NO.
4
1 Z-�) 171�_' ��006 Jrm
2rr
LOT 'BLOCK SU D VIS; Io� f y LEGAL DESCRIPTION:
O ER v P ONE PHONE
MiTINGAWRESS ZIP Actual Set ks in Feet to:
- North South East West
CONT O LICENSE EXPIRES PHONE Siz�of Parcel 7f% Zor lasg'fi tion CCoom�menrcaal ❑
4.
ADDRESS ZIP TypeQ4. upancy Sprinklered
�/ fes) ❑Yes ❑No ❑Req'd.
DESIGNER PHONE New Const. Valuation Remodeled Valuation Total Bldg. Floor Area
5.
ADDRESS ZIP Main Flow Upper Floors Garage/Storage Greenhouse
s. CHANGE OF USE FROM TO Cover Deck Uncv. Deck Fin. Basement Unf in. Basement
TYPE No. Baths No. Floors No. Fin. Rooms No. Dwellings
NEW ❑ALT. ❑ AD' N. ❑OF RpL. O MVE.
7 WORK ❑ BLD. ❑ PLMB. ❑ MECH. M.H. ❑ POOL ❑OTHER Certifi.ofExempt. Required Yes❑ No❑ Number
or Variance Received Yes❑ No❑
DESCRI E WORK 1 l Shorelines/ Flood Hazard Plans Required ❑
8 Lt � �I� ���� �✓ Yes❑ Not Applic. ❑ Received ❑
VALUATION SOOOFCE GAS ELECTRIC PUBLIC
UB ICR SSEWEPT CG Ownership FEES COLLECTED
9• UTILITIES PRIVATE ❑ SEWER ❑ Public ❑ Privat�'�t
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
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 REV SE SIDE FOR REQUIRED INSPECTIONS Plumbing
SIGNATURE OF- APPLICATION
OWNER OR AGENT DATE __` �� Mach.
SPECIAL APPROW
PRELIM. FINAL
Env. Health
Planning
Prevent
Engineer
Utilities
SEPA
Plans
Exam.
SPCIAL CONDITidNS: (SEE REVERSE SIDE FOR NOTICE)
)ATE
1
-11 44Tea 41161
ti
PERMIT IS NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
Plan Check
SEPA
Modular/ 1�
MFG. Home
Other (Specify)
TOTAL $ 100!
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
°
DATE 1�;&li
PERMIT NO. TOTAL
a
O
V
W
J
LL
/Vp�?'ofo-w . /sV.2Y -
R;: KX--,"o
33'