1984, 03-29 Permit: 84A-2729 Addition GaragePLAN 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
STREETADDRESS PARCEL NO.
LOT BLOCK
2. iZ
OW ER
3. - o/i
MAILING ADDRESS
S. 3®15�
CONTRACTOR
4. ADD ESS V'
DESIGNER
5.
ADDRESS
CHANGE OF USE FROM
6.
,�6< ),cvo
WONE I J _ -T-PHONE
v 1.
LICENSE EXPIRES
TO
L,
North .._ South East West
H NE
Size of Parcel
{�
Zone Classification
Residential /K
Commercial ❑
ZIP
Typegt�
u npy
I
Sprinklered
❑Yes ❑No ❑Req'd.
PHONE
New Const, V luation Remodeled Valuation
Total Bldg. Floor Area
ZIP
Main Floor
Upper Floors
Gara a/$to�rallge
[ V
Greenhouse
Cover Deck
Uncv. Deck
Fin. Basement
Unfin. Bas m(
No. Baths I
No. Floors I
No. Fin. Rooms
No. Dwellings
TYPE❑ NgW El ALT. � AD'N. El RPL. ElMVE.
7 OF
WORK BLD. ElPLMB. ElMECH. ElM.H. ❑ POOL ❑OTHER rI
or
Received Yes❑ No❑
DESCRI WOShorelines/Flood Hazard
8• 9- Yes❑ Not Applic. ❑
VALUATION I SOURCE GAS ELECTRIC I WATER SEWAG Ownership
9 PUBLIC SEPTIC Public 10 Privet
UTILILI TIES PRIVATE El SEWER El
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-
thority to violate or cancel the provisions of any other state or local law regulating construction or the performance
of construction. SEE REVERSE SIDE FOR REQUIRED INSPECTIONS
SIGNATURE OFAPPLICATION
�
OWNER OR AGENT G L DATE
SPECIAL APPROVALS SPECIAL LD E REVERSE SIDE FOR NOTICE)
PRELIM. FINAL DATE
Env. Health J�
Planning
Fire
Prevent.
Utilities
Plans PERMIT IS NONTRANSFERABLE
Exam. PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
Building IN 180 DAYS
Tech.
FEES COLLECTED
Building
Plumbing
Mech.
Plan Check
SEPA
Modular/
MFG. Home
Other (Specify)
TOTAL $
WHEN MACHINE VALIDATE
THIS BECOMES A PERMIT.
DATEGJUEl�?_ 9
PERM T NUMBER
-Z,7&
O.
PERMIT NC. " z
PERM"* O O TOTAL
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