1984, 01-13 Permit: 84A-375 InsertPLAN NUMBER
APPLICATION/PERMIT
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
STREET/ADDRESS
1. dLOT
2.
BLOCK SUBDIVISION
3.
OWNER
EetAti
PH NE
PHONE
PARCEL NO.
LEGAL DESCRIPTION:
MAILING ADDRESS
pNTRAC "%tact /�,
/DDMRESS
ISS7 ; ye/Bu)
DESIGNER
LICE�E G I I S
7)7.5 -eel
Actual Set Backs in Feet to:
North 'South [East I West
Size of Parcel 1 Zone Classification
Residential 0
Commercial 0
ZIP
9ya6y
PHONE
Type Const
Occupancy
Spr"nklered
OVes No Reg 'el.
New Const. Valuation
Remodeled Valuation
Total Bldg Floor Area
ADDRESS
ZIP
Main Floor
Upper Floors
Garage/Storage
Greenhouse
CHANGE OF USE FROM
6.
TO
Cover Deck
Uncv Deck
Fin Basement
Unfin. Basement
TYPE 0 NEW ❑ ALT. 0 AD' N. ❑ RPL. ❑ MVE.
7. OF 0 OTHER
WORK BLD. 0 PLMB. O MECH. 0 M.H. 111POOL
No. Baths
No Floors
No. Fin. Rooms
No Dwellings
Certifi. of Exempt.
or Variance
Required Yes❑ No❑
Received Yes❑ No❑
Number
8 ESCRI E WORKK „ Jk/] 3
Shorelines/Flood Han d
VesO Not Applic.0
Pans Required 0
Received 0
VALUATION
9.
SOURCE
F
UTILLIITIES
GAS
ELECTRIC
WATER
PUBLIC 0
PRIVATE 0
AGE
SEPTIC 0
SEWER 0
Ownership
Public 0 Private 0
I hereby certify that I have read and examined this appl'cation 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. SE ..ra ERSE SIDE FOR REQUIRED INSPECTIONS
SIGNATURE OF jPfis
OWNER OR AGENT 4
SPECIAL APP 'VALS
PRELIM. FINAL DATE
Env. Health
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Pans
Exam.
Building
Tech.
//p
APPLICATION //_1,1
DATE
SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
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 $
PERMIT NUMTh.
PAA
04*
04* *2000
*20006
A *0.00
37.42
0.1-13-84
2 6479,
>-
CL
O
W
J
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
�1 hi1Yr-1 N
DATIf .1UEOi '/ r
PERMIT N4.7r 5r=
*20.00/VIAL