1984, 03-22 Permit: 84A-2465 Residence PLAN NUMBER _ APPLICA IC 1/PERMIT PE M TNUMBER
Sr4)KANE COUNTY — DEPARTMENT OF BUILDING&SAFETYA-Z4. '
n> NORTH 811 JEFFERSON/SPOKANE,WASHINGTON 99260/(509)456-3675
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
STREETDDRESS PARCEL NO.
1. , 117Ic� P �.-� z - -- x"50
LOT BLOCK SUBDIVISION 1 LEGAL DESCRIPTION:
OW E I P ONE ��p NE
r� G e r--0d5 c�•ls " `ate - I I01
3. MAIL NG ADDRESS f Ip Actual SetBks in Feet to:
K - 6 C., 12kZL, H i_1 1 ' � � ` North South East/ I west
CONTR CTO LICENSE EXPIRES P ONE Sieo�ce Q� Zone Classification Residential
4. ," C: Commerciafff❑
ADDRESS ZIP Type Copsi. Occur), c Sprinklered
VN lz, Mi ❑Yes ❑No ❑Req'd.
DESIGNER PHONE New Const.Valuation Remodeled Valuation Total Bldg.Floor Area
5. 0 .7 . , ,
ADDRESS ZIP Main Fl r Upper Floors Garage/Sto - reenhouse
1 C+
6. CHANGE OF USE FROM TO Cover Deck Un Deck Fin.Basement, —Uynfin�Baggment
No.Baths No.Floors No.Fin.Rooms No.Dwellings
TYPE NEW ❑ ALT. ❑ AD'N. ❑ RPL. ❑ MVE.
7, OF ❑ OTHER
WORK BLD. ❑ PLMB. ❑ MECH. ❑ M.H. ❑ POOL Certifi.of Exempt. Required Yes❑ No❑ Number
or Variance Received Yes Non /�
DESCRIBE WORKyShorelines/Flood Hazard Plans Required j:
8. P��L!9 X-4\I ��', --rz �.[ (� / Yes Not Applic.❑ Received C
VALUATION SOURCEOGAS s ELECTRIC PUBLICTER/ SEPTIC Ownership FEES COLLECTED
9• UTILITIES PRIVATE D SEWER❑ Public❑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 air ',5o
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 REVERS SIDE FOR EQUIRED INSPECTIONS Plumbing
SIGNATURE OF ',.../�✓ APPLICATION /� ,r/
OWNER OR AGENT E l` DATE 1 Mech.
' SPECIAL APPROVA S SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PRELIM. FINAL DATE Plan Check
Env.HealthAleb124
SEPA
Planning
Modular/
MFG.Home
Fire
Prevent. ' O
I Other(Specify) C.,
Engineer ' '� d•( �� d •
'J �Utilities yL
"
TOTAL $
SEPA
WHEN MACHINE VALIDATED IN THIS SPACE,
Plans / PERMIT IS NONTRANSFERABLE THIS BECOMES A PERMIT.
Exam. r �// PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
cBuilding , . / IN 180 DAYS .4� 2 — �. �6. z * 3 Q. 0 a I
I/, DATSiJE PERMI 5 o TOTAL
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