1984, 02-03 Permit: 84A-993 GaragePLAN NUMBER APPL ICAT ION /PERMIT PERMIT NUMBER
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 j DRESS PARCEL NO.
3
LOTBLOCK
2.-
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LEGAL DESCRIPTION:
OWNERI
PHONE
MI./
-2,
MAILING AD RESS _ZIP
ActualSet Backs in Feet to:
4-11����
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North South East West
CONTRACTOR
LICENSE EXPIRES
PHONE
Size
Parcel
Zone Classification
Residential
4.
mar
ADDRESS
ZIP
TypeCgnst
Occu ncy
Sprinklered
❑Yes El No ❑Req'd.
V
DESIGNER
PHONE
New Const. Valuation
Remodeled Valuation
Total Bldg. Floor ,area
ADDRESS
ZIP
Main Flo6r Upper
Floors
Garare/St rage
Greenhouse
tl C1
CHANGE OF USE FROMTO
Cover Deck
Uncv. Deck
Fin. Basement Unf in. Basement
6.
TYPE EfNEW El ALT. ❑ AWN. 1-1 RPL. ❑ MVE.
No. Baths No.
Floors
No. Fin. Rooms
No. Dwellings
7. OF ❑ OTHER
Certifi.ofExempt.Required
Yes El No❑
Number
WORK dBLD. ❑ PLMB. ❑ MECH. ❑ M. H. ❑ POOL
or Variance
Received Yes❑ No❑
DESCRIBEWORK
8.
Shorelines/ Flood Hazard
Plans Required
Yes Not Applic. ❑
Received
VALUATION I
9
SOUROFCE
GAS
ELECTRIC
UB TEIR
PUBLIC
SEPTIC E
Ownership
FEES COLLECTED
UTILITIES
PRIVATE El
SEWER ❑
Public El PrivateP(
1 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-
Building ,C?
thority to violate or cancel the provisions of any other state or local law regulating construction or the performance
of construction. SEE REVERn SIDE FOR REQUIRED INSPECTIONS
Plumbing
SIGNATURE OF APPLICATION -�
��
OWNER OR AGENT „t DATE %�
Mech.
SPECIAL APPROVALS
SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PRELIM. FINAL DATE
Plan Check
Env. Health
SEPA
Planning
Modular/
MFG. Home
>
ire
Prevent.
Other (Specify)
C
C.
Engineer
C `
U
U
Utilities
TOTAL $
SEPA
PERMIT IS NONTRANSFERABLE
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
Plans
Exam.
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
Buildingtp
IN 180 DAYS
((�� � n o 0
3 O_
9' 3 c5 * 9 6,
DATEISSUEDO PERMIT NO2. *tAL
I
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