1984, 03-21 Permit: 84A-2437 AdditionPLAN NUMBER APPLICA-If d,,,^1/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 PARCEL NO.
LOT BLOCK SU Dlvlslo rW
LEGAL DESCRIPTION:
2.
OM
P ONE PHONE
MAILING ADDRESS
Actual Set Backs in Feet to:
E71 + 2_411"�zr____5 +-
/
i
North South East
West
CONTRACTOR
�� s�'�(tel
LICENSE EXPIRESPPHPO
NE
Size f Parcel
c
Zone Classifica ion
Residential
Commercial ❑
4. Q
ASS
-
Type st
N1 KJ
pay
Sprinklered
❑Yes ❑No ❑Req'd.
DESIGNER
NE
New nst. Valuation
Remodeled Valuation
Total Bldg. Floor Area
Z L�
5.
ADDRESS
-
ZIP
Main Floor Upper
Floors
Garage/Storage Greenhouse
CHANGE OF USE FROM
Cover,
Uncv. Deck
o
Fin. Basement
Unfin. Basement
s.
TO—
�—.__
No.
Floors
No. Fin. Rooms
No. Dwellings
TYPE 11 NEW El ALT. AD'N. ❑ RPL. El MVE.
tt�l
7• OFDOTHER
WORK ALD. El PLMB. 11 MECH. El M.H. 11 POOL
Certifi. of Exempt.
Required
Yes ED No❑
Number
or Variance
Received
Yes No
DESCRIBE WORK
8red
•,-kot% ct�
Shorelines/ Flood Hazard
Plans Requi
✓�
� 11
Yes❑ Not Applic. ❑
Received
VALUATION
9.
SOURCE
GAS
ELECTRIC
PUBLICR❑
SSEWAGE EPTICV
Ownership
Public ❑ Private
FEES COLLECTED
UTILITIES
PRIVATE ❑
SEWER
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 REVERSE SIDE FOR REQUIRED INSPECTIONS
���'''
Plumbing
SIGNATURE OF APPLICATION
� /, / P
OWNER OR DATE
Mach.
SPECIAL A ROVALS
SPECIAL CONDITIO :(SEE REVERSE SIDE FOR OTICE)
PRELIM. FINAL DATE
l..+ _ I 1
��� � IC V � 5 f
Plan Check
Env. Health
f
SEPA
Planning
Modular/
Fire
MFG. Home
Prevent.
Utilities
SEPA
Plans PERMIT IS NONTRANSFERABLE
Exam. .� PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
Building
Tech. IN 180 DAYS
3 .
PERMIT NUMBER
Other (Specify)
TOTAL $
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS( B�jECO7M1ES A PERMIT. /�
DATEYJED t y 3 4 PERMIT'. 3/ 7
z * 1 0 0 fiOh•AL
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