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-