1984, 02-14 Permit: 84A-1220 ResidencePLAN NUMBER APPLICATION /PERMIT PERMjT14UMBE
- �� J
SPOKANE COUNTY - DEPARVIENT OF BUILDING & SAFETYb+t
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES —PRESS HARD TO MAKE 3 COPIES
STREETADDRESS PARCEL NO.
1. �- 5 � � X4-1- _001
2 L7T
I By CK
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SUBDIV�i N 2 � O k Io�
T`�
LEGAL DESCRIPTION:
OW.NE j„
PHONE
PHONE
�
3.
MAILING ADDRESS
ZIP
Actual Sqt/Pecks in Feet to',,, 30
North It(✓ South d East West
CONTRACTOR
LICENSE EXPIRES
P O E
SI Ael
Zol
ngCassi i tin
Residential
4.
_
4>
Commercial ❑
A�RESS, , ^
Ks
/
Type st.
'
Sprinklered
❑Yes ❑No ❑Req'd.
DESIGNER
PHONE
New Wt Valuation
Remodeled Valuation
Total Bldg. Floor Area
S.
7L)
!r
ADDRESS
ZIP
Mai Floor
Floors
Garage/S)or�
Greenhouse
CHANGE OF USE FROM
TUpperr
Cover Deck
n�.}�eccic
Fin. Basement
Unfin Basement
7�0__
6
r
/
W ❑ ALT. ❑ AWN. ❑ RPL. ❑ MVE.
J2BLD.
No. Baths No.
Floors
No. n. Rooms
No. Ilings
7 TYPE
❑OTHER
!'-
Certifi.ofExempt.
Required Yes No
Number
WORK ❑ PLMB. ❑ MECH. ❑ M.H. ❑ POOL
or Variance
Received Yes❑ No❑
DESCRIBE WORK
8 c4f,
Shorelines/ Flood Hazard
Plans Required ❑
1
Yes❑ Not Applic. ❑
Received ❑
VALUATION
SOOURCE
GAS
ELEC RIC WA ER
PUB9•
SEPWAGE
Ownership
FEES COLLECTED
UTILITIES
PRIVATE ❑
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��
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 RfAHtMED INSPECTIONS
Plumbing
SIGNATURE OF APPLICATION
OWNER OR A T - DATE
Mach.
SPECIAL APPROVALS
SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PRELIM. FINAL DATE
� � �
C LA G C �0p� i j .tom 7 3 C�-�1
i �T /lam
Plan Check
Env. Health `
I /!
w �{
SEPA
Planning
Modular/
Fire
MFG. Home
Prevent.
Engineer I F110
Utilities
Plans PERMIT IS NONTRANSFERABLE
Exam. PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
Building
Tech, IN 180 DAYS
t �f
Other (Specify)
TOTAL $
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT. 1l �
DAT;I�UE; '� T PERM14mb , 0 � * 3 5 u. 10 li aQ�Al_
0
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