1984, 02-10 Permit: 84A-1169 Residence PLAN NUMBER APPLICATION/PERM IT PERMIT NUMBER
SPOKANE COUNTY — DEPARTMENT OF BUILDING & SAFETY e4A- — i i bq
NORTH 811 JEFFERSON/SPOKANE,WASHINGTON 99260/(509)456-3675
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
STREET ADDRESS
PARCEL NO.
iZ to. v_occ2cca.c- -354.41--— 12_0
LOT BLOCK SUBDIVISION LEGAL DESCRIPTION:
2. LE N. lac. ' vt Ey2 Gs`.c � 7,pze.L(c.,cs
OWNER PHONE PHONE CrkG " ��rTTt E .�1
3. '''' .-c'z..Pw N k. C,' q&--%-<.:,044A‘-7
MAILING ADDRESS ZIP Actual Set Backs in Feet to:
£- 1-10-al 4 c tc'Yc-tZ\4. North`Zv 4" 1 South Z.c.,(, East may' I West
CONTRACTOR LICENSE EXPIRES PHONE Size of Parcel Zone Classification Residential l "
4. (-1-1_ 1.).(z-, e'vt.c` '-1-5 tc t sd Commercial❑
ADDRESS ZIP Type Const. Occupancy Sprinklered
"-b.fslv�E j_-'I ❑Yes ❑No ❑Req'd.
DESIGNER PHONE "Few Const.Valuation Remodeled Valuation Total Bldg.Floor Area
5. ADDRESS'`GO - ..! �t L
ZIP Main Floor Upper Floors Garage/Storage Greenhouse
4:V. g
CHANGE OF USE FROM TO Cover Deck Uncv.Deck Fin.Basement Unfin.Basement l U os. '� J '- c L 0 FI y:
TYPE � / No.Baths No.Floors No. Rooms No.Dwellings
7• OF ❑ OTHER
NEW ❑ ALT. El N. ❑ RPL. ❑ MVE. '' 1 v
1
WORK BLD. ElPLMB. ❑ MECH. ElM.H. El POOL Certifi.of Exempt. Required Yes NoIX Number
or Variance Received Yes No❑
DESCRIBE WORK Shorelines/Flood Hazard
8. ---�.I r Plans Required IFI"; v [I
-oC.-S ,Y7GNC Yes Not Applic.❑ Received Cif L
VALUATION SOURCE GAS ELECTRIC WATER SEWAGE/ Ownership FEES COLLECTED L
9. OF PUBLIC SEPTIC d
UTILITIES PRIVATE❑ SEWER 0 Public 0 Private
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
work will be complied with whether specified herein or not. The granting of a permit does not presume to give au Building ici .Goo
thority to violate or cancel the provisions of any other state or local law regulating construction or the performance
of construction.SEE REV SE SIDE FOR REQUIRED INSPECTIONS Plumbing
SIGNATURE OF APPLICATION
OWNER OR AGE ,"11 -_! - 414 - - ' 1- 2-- Mech.
SPECIAL APPROVALS SPECIAL CONDITIO :(SEE REVERSE SIDE FOR NOTICE)
PRELIM. FINAL DATE Plan Check
Env.Health
S,r. 8
SEPA
Planning
Modular/
Fire MFG.Home
Prevent. >-
a
Engineer 0
Other(Specify) t.)
UtilitiesfieeitriAL
LIU
--1
LL
SEPA TOTAL $ I%-0C:1
WHEN MACHINE VALIDATED IN THIS SPACE,
Exam.ln �"j/ fl/ � PERMIT IS NONTRANSFERABLE THIS BECOMES A PERMIT.
Building
' ��- , /moi PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
Tech. ?.?
\ �{ IN 180 DAYS (� k' 11pJ // DATEYSZED1 0 - 8 4 PERMITIIC1 6.9 5 * 1 9 8. 0 0 YIppAL
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