1984, 03-26 Permit: 84A-2576 AdditionPLAN 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 PARCEL NO.
. - 11315 N � v �� 5 4-4- - zoo 2 -,LOT BLOCK SUBDIVISION A�^, LEGAL DESCRIPTION:
OWN ✓� J PHONE HOSE_ � g
3. MAILING ADDR SS ✓ 1� ZI Actual Set Backs in Feet to:
SPECIAL APPROVALS SPECIAL CONDITIONS: (SE REVERSE SIDE FOR NOTICE)
PRELIM. FINAL DATE Z 2c?
Env. Health L `" I C"
Planning
Utilities
SEPA
pians�G, PERMIT IS NONTRANSFERABLE
Exam./ PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
Building IN 180 DAYS
Tech. fU Z )
Plan Check
SEPA
Modular/
MFG. Home
Other (Specify)
TOTAL $ `
PERMIT NUMBER
OJ
A -` C2 162
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATE WWdbdb I _ q A PERMIT 16 7 6 5 9 6. 01, �- TOTAL
u
f
North South v/ East
West
CONTRACTOR
LICENSE EXPIRES
7
Sizer I
Zo�Clas
if' t'o
Residential
Commercial ❑
4. �26r
ADDRESS
/Y��
v��
Type St.
u ncy
Sprinklered
Dyes ❑No ❑Req'd.
DESIGNER
PHONE
NewCr alyatioq
Remodeled Valuation
Total Bldg. Floor Area
5.
��
ADDRESS
ZIP
Main FI Upper
Floors
Garage/Storage
Greenhouse
CHANGE OF USE FROM
TO
Cover Deck
Uncv. Deck
Fin. Basement
Unfin. Basement
6.
_
TYPE ZAD'
No. Baths No.
Floors
No. Fin. Rooms
No. Dwellings
;E3 NEW 13ALT. N. ElRPL.
7.
_BLD.
1:1 MVE.
❑OTHER
WORK 11 PLMB. ❑ MECH. 1:1 M.H.
El POOL
Certifi.ofExempt.
Required
Yes❑ No❑
Number
or Variance
Received
Yes No[-]
8 DE WRFS„ A rn
�G�I(/
Shorelines/ Flood Hazard
Plans Required
��/j
Yes❑ Not Applic. ❑
Received
VALUATION
I SOURCE
GAS
ELECTRIC
pUBLICR
SEPTAL E
Ownership
FEES COLLECTED
9•
UTILITIES
PRIVAT ❑
SEWER ❑
Public ❑ Private
I hereby certify that 1 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 specifiedCe 'n or not. The granting of a permit does not presume to give au -Building
thority to violate or cancel th ovions of aof er s
t local law regulating construction or the performance
of construction. SEE REVER S F EIR D
S
Plumbing
SIGNATURE OFL
APPLICATION
OWNER OR AGENT
DATE
Mach.
SPECIAL APPROVALS SPECIAL CONDITIONS: (SE REVERSE SIDE FOR NOTICE)
PRELIM. FINAL DATE Z 2c?
Env. Health L `" I C"
Planning
Utilities
SEPA
pians�G, PERMIT IS NONTRANSFERABLE
Exam./ PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
Building IN 180 DAYS
Tech. fU Z )
Plan Check
SEPA
Modular/
MFG. Home
Other (Specify)
TOTAL $ `
PERMIT NUMBER
OJ
A -` C2 162
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATE WWdbdb I _ q A PERMIT 16 7 6 5 9 6. 01, �- TOTAL
u
�O