1984, 02-16 Permit: 84A-1317 InsertPLAN 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
1. ' ? ti �o
LOT
2.
3f�S
BLOCK SUBDIVISION
PARCEL NO.
OWNER
3 SC(7TC I-'' i{11i.?S
MAILING ADDRESS
ti . - CooeP —?sa •
PHONE
PHONE
cb.c, 6- 0
LEGAL DESCRIPTION:
ZIP
CIC'2C C
Actual Set Backs In Feet to'
North 'South
4.
CONTRACTOR
't7i4 ni.r)
LICENSE EXPIRES
PHONE
Size of Parcel
11 Zone Classification
East
West
Residential 0
Commercial 0
ADDRESS
ZIP
Type Const.
Occupancy
Sp nklered
DYes ONo OReq Id.
5.
DESIGNER
PHONE
New Const. Valuation
Remodeled Valuation
Total Bldg. Floor Area
ADDRESS
ZIP
Main Floor
Upper Floors
Garage/Storage
Greenhouse
CHANGE OF USE FROM
6.
TO
Cover Deck
Uncv. Deck
Fin Basement
UnfIn. Basement
TYPE 0 NEW 0 ALT. 0 AD' N.
7. OF 0 BLD. 0 PLMB. C/MECH.
WORK
O RPL.
O M.H.
❑ MVE.
D POOL
0 OTHER
No. Baths
No. Floors
No Fin Rooms
No. Dwellings
Gerbil. of Exempt.
or Variance
Required YesD NoL
Received Yes0 No0
Number
DESLABE WORK
8' ..1g- .r12£P�F3(E
Liu 2-r Rya tCcz.O Gl_Atzatlair
Shorelines/ Flood Hazard
VesO Not Appllc. 0
Plans Required 0
Received 0
VAI DATION
9. t
SOURCE
OF
UTILITIES
GAS
ELECTRIC
WATER
PUBLIC 0
PRIVATE 0
SEWAGE
SEPTIC 0
SEWER 0
Ownership
Public D Private 0
I hereby certify that I have read and examined this appl cation 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-
thority to violate or cancel the provisions of any other state or local law regulating construction or the performance
of construction. SEE REVERSE IDE FO EOUI DIN P CTIONS
SIGNATURE OF
OWNER OR AGENT
SPECIAL APPROVALS
PRELIM. FINAL DATE
Env. Health
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
APPLICATION i lv /c3y
DATE
SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PERMIT IS NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
FEES COLLECTED
Building
Plumbing
Mech.
Plan Check
SEPA
Modular/
MFG. Home
Other (Specify)
TOTAL $ 20.01
PERMIT NUMBER
94A - 1311
04* *20.00
131.68
02-16-84
2 6479.
•
0
O
V
W
—J
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATE
X16' --'B.4
PERMITIO. 17 2 * 2 0. 0 0 TxiPAL