1984, 01-24 Permit: 84A-677 Special InspectionPLAN 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
STREETT TRESS PARCEL NO.
2. LOT BLOCK SUBDIVISION LEGAL DESCRIPTION:
01. R i r - JPHONE PHO �f
7 `
3.
MAILING ADDRESS�_
ZI$�
C� 204
Actual Set Backs in Feet to:
North South East
West
CONTRACTOR
LICENSE EXPIRES
PHONE
Size of Parcel
Zone Classification
Residential ❑
4.
Commercial ❑
ADDRESS
ZIP
Type Const. Occupancy
Sprinklered
❑Yes ❑No ❑Req'd.
DESIGNER
PHONE
New Const. Valuation
Remodeled Valuation
Total Bldg. Floor Area
J.
ADDRESS
ZIP
Main Floor Upper
Floors
Garage/Storage
Greenhouse
CHANGE OF USE FROM
TO
Cover Deck
Uncv. Deck
Fin. Basement
Unfin. Basement
s.
No. Baths No.
Floors
No. Fin. Rooms
No. Dwellings
TYPE ❑NEW ❑ALT. El AWN. El RPL. ❑ MVE.
7. j2�OTHER
OF
WORK ❑ BLD. ❑ PLMB. ❑ MECH. ❑ M.H. ❑ POOL
Certifi.ofExempt.
Required
Yes❑ No❑
Number
or Variance
Received
Yes❑ No❑
8. DESCRIBE WORK(•. _ �r�' i
Hazard
ReqReceiired 11
,
Plans
esalinesNotA
ved ❑
VALUATION I
SOOUFCE
GAS
ELECTRIC
PUBLIC ❑
SEPT ICG
Ownership
FEES COLLECTED
9.
UTILITIES
PRIVATE ❑
SEWER ❑
Public ❑ Private ❑
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
thority to violate or cancel the provisions of any other state or local law regulating construction or the performance
of construction. SEE REVEPAE SIDE FOR REQUIRED INSPECTICINS
Plumbing
SIGNATURE OF APPLICATION
OWNER OR AGENTAd6::�4DATE
Mach.
SPECIAL APPROVALS SP IAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICI
PRELIM. FINAL DATE
Env. Health
Planning
Fire
Prevent.
Utilities
PlansPERMIT IS NONTRANSFERABLE
Exam. PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
Building IN 180 DAYS
Tech. % ,�
Plan Check
SEPA
Modular/
MFG. Home
On
Other (specify)59 1 Oel
TOTAL $
PUMITNLIMBER
W — 6111
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES RAP1ERMIT. x
..T.11. C17- — 4 DCORAIT W6 7, I a6 * V. � O L4TAI
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