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1984, 01-24 Permit: 84A-676 MHPLAN NUMBER APPLICATION/PERMIT SPOKANE COUNTY — DEPARTMENT OF BUILDING & SAFETY NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675 PERMIT NUMBER 8 DESCRIBE WORK M0811-4 Kt v" IF Po�V � r t t Yes0Shorelines/ of A Hazard Plans Required ❑ W Yes❑ NotApplic.+J'd' Received ❑ VALUATION I SOURCE GAS ELECTRIC WATER SEWAGE Ownership FEES COLLECTED 9 OF PUBLICI!L SEPTIC Public ❑ Privateo UTILITIES PRIVATES ❑ 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 FO .REQUIRED INSPECTIONS Plumbing r= SIGNATURE OF i APPLICATIO l� OWNER OR AGENT ?`�-7v z= r-'� DATES Mach. SPECIAL APPROVALS SPECIAL CON (TIONS: (SEE REVERSE SIDE FOR NOTICE) Plan Check PRELI AFI AL DATE_ Env, Healt / (/ ✓t G �� SEPA PI I g Modular/ �l MFG.Home Fire // r Prevent. C n Other (Specify) L Engineer Utilities Plans I i I I PERMIT IS NONTRANSFERABLE Exam. PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED Building IN 180 DAYS Tech. W1 �44 TOTAL $ I WHEN MACHINE VALIDATED IN THIS SPACE, THIS BECOMES A PERMIT. {1 ll a DATE ED k/ PERMIT NO ? z * O U TOTAL L APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES ❑Yes ❑No ❑Req'd. DESIGNER — STREETADDRESS Remodeled Valuation PARCEL NO. +� _ r 5. 2. LOT BLOCK SUBDIVISION '4pp r i vi'J LEGAL DESCRIPTION:./ 1,40ftV4 �' r • oV'T 5 Rre 'T ` I v 1Ii OWNER PHONE PHONE 3. CHANGE OF USE FROM /i % A� ''/ - �i ' Uncv. Deck F Pt'f t� PA's Unfin. Basement 6. MAILING ADDRESS _ zip ;- Actual Set Backs in Feet to. North South East West' CONTRACTOR 11 LICENSE EXPIRES PHONE Size of Parcel Zone Qlassification Residential] 1Commercial 4. �;v 7TY ❑ BLD. ❑ PLMB. ❑ MECH. eM.H. ❑ POOL O �c"f 16 xempt.Required ADDRESS Number I ZIP I TvDeConst. I Occuoancv I Sprinklered PERMIT NUMBER 8 DESCRIBE WORK M0811-4 Kt v" IF Po�V � r t t Yes0Shorelines/ of A Hazard Plans Required ❑ W Yes❑ NotApplic.+J'd' Received ❑ VALUATION I SOURCE GAS ELECTRIC WATER SEWAGE Ownership FEES COLLECTED 9 OF PUBLICI!L SEPTIC Public ❑ Privateo UTILITIES PRIVATES ❑ 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 FO .REQUIRED INSPECTIONS Plumbing r= SIGNATURE OF i APPLICATIO l� OWNER OR AGENT ?`�-7v z= r-'� DATES Mach. SPECIAL APPROVALS SPECIAL CON (TIONS: (SEE REVERSE SIDE FOR NOTICE) Plan Check PRELI AFI AL DATE_ Env, Healt / (/ ✓t G �� SEPA PI I g Modular/ �l MFG.Home Fire // r Prevent. C n Other (Specify) L Engineer Utilities Plans I i I I PERMIT IS NONTRANSFERABLE Exam. PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED Building IN 180 DAYS Tech. W1 �44 TOTAL $ I WHEN MACHINE VALIDATED IN THIS SPACE, THIS BECOMES A PERMIT. {1 ll a DATE ED k/ PERMIT NO ? z * O U TOTAL L v- 3 ❑Yes ❑No ❑Req'd. DESIGNER — PHONE Remodeled Valuation Total Bldg. Floor Area _ r 5. ADDRESS ZIP Upper Floors Garage/Storage Greenhouse CHANGE OF USE FROM TO Fnalual.icValuation Uncv. Deck Fin. Basement Unfin. Basement 6. No. Floors No. Fin. Rooms No. Dwellings TYPE XNEW ❑ALT. ❑AD'N. ❑RPL. ❑ MVE.❑OTHERWORK 7TY ❑ BLD. ❑ PLMB. ❑ MECH. eM.H. ❑ POOL xempt.Required Yes❑ No❑ Number Received Yes❑ No❑ PERMIT NUMBER 8 DESCRIBE WORK M0811-4 Kt v" IF Po�V � r t t Yes0Shorelines/ of A Hazard Plans Required ❑ W Yes❑ NotApplic.+J'd' Received ❑ VALUATION I SOURCE GAS ELECTRIC WATER SEWAGE Ownership FEES COLLECTED 9 OF PUBLICI!L SEPTIC Public ❑ Privateo UTILITIES PRIVATES ❑ 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 FO .REQUIRED INSPECTIONS Plumbing r= SIGNATURE OF i APPLICATIO l� OWNER OR AGENT ?`�-7v z= r-'� DATES Mach. SPECIAL APPROVALS SPECIAL CON (TIONS: (SEE REVERSE SIDE FOR NOTICE) Plan Check PRELI AFI AL DATE_ Env, Healt / (/ ✓t G �� SEPA PI I g Modular/ �l MFG.Home Fire // r Prevent. C n Other (Specify) L Engineer Utilities Plans I i I I PERMIT IS NONTRANSFERABLE Exam. PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED Building IN 180 DAYS Tech. W1 �44 TOTAL $ I WHEN MACHINE VALIDATED IN THIS SPACE, THIS BECOMES A PERMIT. {1 ll a DATE ED k/ PERMIT NO ? z * O U TOTAL L VA]; ADD-RESS-1 ZONE: ROAD WIDTH: . FRONT, --,T-4'- �LAN,KINC: COMMENTS..4 , REVIEWED BY-