1984, 02-07 Permit: 84A-1166 ResidencePLAN NUMBER I APPL ICA,T IN /PERMIT
SPOKANE COUNTY - DEPARTMENI-OF BUILDING & SAFETY
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES —PRESS HARD TO MAKE 3 COPIES
STREET ADDRESS � w` PARCEL NO.
L T BLOCK SUBDIVISION LEGAL DESCRIPTION:
2. 2 NA U tea . A'U!g
WN PHONE PHONE
3.
MAILING ADDRESS
ZIP
Actual Set Backs in Feet to: I
I
SFlECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
Env. Health
/Planning
r Fire
Prevent.
North 3� t t South 10 East 10I West I?
CONTRACT
LICE EX IRE
PHO
zeof rcell / r
Zone Classification
Residential
A
4. '
(�
`t'
f
Commercial is ❑
ADDRE
ZIP
Ty Occupancy
Sprinklered
Utilities
❑Yes ❑No ❑Req'd.
DESIGNER
PHONE
New Const. Valuation
Remodeled Valuation
Total Bid Floor Area
5.
Plans
Exam.
Building
Tech.
L 5
ADDRESS
ZIP
Main FI r Up
r Floors
GaragelStor�ge Greenhouse
,
} `J" F'
CHANGE OF USE FROM
TO
Cover Deck
Uncv. Deck
Fin. Basement
U fin. Ejasem
6.
CIE
tq �
TYPE )4NEW ❑ ALT. ❑ AD'N. ❑ RPL. ElMVE.
No. Baths No.
Floors
No. Fin. ooms
No. Dwellings
7• OF ❑ OTHER
`
Certifi. of Exempt. Required
Yes❑ No❑
Number
WORK JMBLD. ❑ PLMB. ❑ MECH. ❑ M.H. ❑ POOL
or Variance Received
Yes❑ No❑
ri FVXL ,y�
8 DESCRIBEWORK �� �� �R! � 7� �� CMI
Shorelines/ Flood Hazard
Plans Required El
p t
Yes❑ Not Applic. ❑
Received ❑
VALUATION
9•
I SOOUFCE
GAS
ELECTRIC
pUBLICj�
SEPTIAC E
Ownership
FEES COLLECTED
UTILITIES
PRIVATES LLJJ
SEWER
Public ❑ Private W:
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 of1
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 APPLICATIONS 7 -
°, 'L
OWNER ORA( DATE
Mach.
SPECIAL
APPROVALS
SFlECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
Env. Health
/Planning
r Fire
Prevent.
PRELIM.
FINAL
DATE
Ll G 0 tAAw fJ i.N i74NL3
�j� puCOONNT KC /�.$i `r%"--+�i•Q�171"�G��� t1ir� PrrAul
�1" Gr�Y►»�h(T Pvr� 1
7l�GI S�Ul±�i1�
^
J�J
Engineer
�?
Utilities
SEPA
Plans
Exam.
Building
Tech.
PERMIT IS NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
17
j(eU
F
,
Plan Check
SEPA
Modular/
MFG. Home
Other (Specify)
TOTAL $ 4
PERMIT NUMBER
o
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES APERMIT.
DATEUED` O—o U' U
z * 412,
PERMITi%IFAL
a
O
C3
W
J
LL
K�.Co'I
9