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1984, 04-17 Permit: 84A-3403 Addition PLAN NUMBER APPLICATION/PERMIT PERMIT NUMBER - SPOKANE COUNTY — DEPARTMENT OF BUILDING &SAFETY - `' r NORTH 811 JEFFERSON/SPOKANE,WASHINGTON 99260/(509)456-3675 sim- APPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 3 COPIES • STREET ADDRESS PARCEL NO. 1. 4-3i`I 4 v 4k L-CotA.i d S41 - C, '7 LOT BLOCK SUBDIVISION LEGAL DESCRIPTION: 2. I, Z- Z N�IL���c c OWNER PHONE P�I�ONE L t CL.W P V fv Cl2� —770- 3. My�A,ILING,ADDRESS ZIP y/� Actual Set Backs in Feet to:�i K.c-,r VI A. f ) t 4-5 tri AV A-E.- 'N get 2-i North !South East I West CONTRACTOR LICENSE EXPIRES PHONE Size of Parcel Zone Classification Residential e. 4. 5 PILM.#' ( 70 IQ et-c;) b4C--i.l l Commercial 0 % ADDRESS ZIP Type s �r Oyes ONoSprinklerte ❑Req'd. DESIGNER PHONE • ,t.Valuation Remodeled Valuation Total Bldg.Floor Area 5. T 4.a o tO ADDRESS ZIP Main Floor Upper Floors Garage/Storage Greenhouse fOz_c? CHANGE OF USE FROM TO Cover Deck Uncv.Deck Fin.Basement Unf in.Basement 6. / No.Baths No.Floors No.Fin.Rooms No.Dwellings 7 TYPE ❑ EW 0 ALT. t AD'N. 0 RPL. 0 MVE.OF ❑ OTHER x WORK —' OLD. 0 PLMB. 0 MECH. 0 M.H. 0 POOL Certifi.of Exempt. Required Yes❑ No� Number or Variance Received Yes❑ No E1 -// DE RIBE WORK Shorelines/Flood Hazard Plans Required C9' ' 8, Abp --co 's l i.,6-'/%..>C. - Yea❑ Not Applic.0 Received 0 ) VALUATION SOURCE GAS ELECTRIC WATE SEWAC�� Ownership FEES COLLECTED 9. LI PUBLIC SEPTIC Public 0 Private❑ UTILITIES PRIVATE SEWER❑ 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 Building t 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 Plumbing SIGNATURE OF / APPLICATION f, OWNER OR AGEN ' '. '' -- _ DATE At / fk-N Mech. SPECIAL APPROVALS SPECIAL CONDITIONS:(SEE REVERSE SIDE FOR NOTICE) PRELIM. FINAL DATE G x c t (tea( ra(A,,ngf4 ( cy rt.i Plan Check Env.Health k . c e- :Z. 2-4-eA9 SEPA Planning Modular/ MFG.Home Fire II. �, Prevent. 0 ' O Engineer Other(Specify) V W J x Utilities `8y ' _ TOTAL $ Gia SEPA .Su1:33cc'r .zr dn(f` e 1 i)0sPEG?i MACHINE Plans PERMIT IS NONTRANSFERABLE THFIS EN BECOMES A PERM TTED IN THIS SPACE, Exam. PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED (J (j /� L Budding 8112'd / IN 180 DAYS DATEYSSUEI� 7 _8 4 PERMITU.O, 3 2 *1 8 6, O 0 SALTech. V • BUILDING PERMIT APPLICATION WORKSHEET PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND (Please return this original and your building plans to the Department of Building and Safety) 1 Owner's Name (last) p(first) (m) Department Use Only Le 1^7 v! ' Fes. Comm 2 Project Address(not Mailing Address)or Road Name Space Zip $ ' 43i. 4.Li L 4"'J g43.:,.,t 3 City/Community State Subdivision/Plat Name J�, 4 Assessor Parcel No. Lot Block Yt r` * * * DEPARTMENT USE ONLY * * * 5 Sic Code Zone Act.# Zone A ` Project No. 6 Dwell# No.of Buildings Sq.Ft./Acre Depth Frontage i 1 4 tic, 7 Set Back-Front I(L)S-1 (R)S-2 I Rear Census Tract Module No. Initials i_ * * 16 Architect Firm Name Street Address Zip City State Phone ( ) Contact Person Phone if different than above ( ) Contractor Firm Name Street Address Zip City State Phone ( ) Contact Person License No. Phone if different than above ( ) 8 Owner/Agent(if different than#1 above) Business Address r 9 Zip City State Phone ( ) 12 Review Required Plan Check(Y/N) Other(Y/N) SEPA Exempt(Y/N) Date 15 Type Work 3- Bidg ❑ MH ❑ New E Replace ❑ Other ❑ Fire ❑ Demo 7 Add/Alter ❑ Move 14 Describe Work 10 Applicant NameStreet Address , / • kI V , r 11 Zip City State Phone ( ) * Lender Street Address Zip City State Phone ( ) , Contact Person Phone if different than above ( 1 Additional Information J6E -2-4-61.6( c l -r-l CrAiCA u.uU 06 vc cf,,A) DEPARTMENT APPROVALS This is nota Permit Application Type (Standard unless (Indicated approvals required in either"release"or"release with conditions" otherwise indicated) space prior to permit issuance.) ❑ Fast Track ❑ Early Start Release Release w/cond 1 Hold 2 Environmental Health ❑ Commercial; iResidential W.1101 College ❑ New Construction; ❑ Bldg alteration/addition Room 200 ❑ Additional structure; IAPPLICATION# Conditions/Comments: ❑ Planning/Zoning: ❑ Commercial; ❑ Cert.of Exemption; ❑ Frontage; N.721 Jefferson ❑ Setbacks; ❑ lot w/d; ❑ lot size; ❑ use/zone; ❑ CU,variance,zone change;shoreline; ❑ fence; ❑ Other Conditions/Comments: 1 ❑ Engineers: ❑ Commercial; ❑ Residential; ❑ Flood Plain; I N.811 Jefferson ❑ drainage ❑ new access/approach; ❑ fence; ❑ road improvements Conditions/Comments: ❑ Utilities: N.811 Jefferson Conditions/Comments: Other: ❑ Plan Exam Fire Prey. 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