1984, 01-04 Permit: 84A-087 RemodelPLAN 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
STREETADDRES PARCEL NO.
1-71
LOT BLOCK SUBDIVISION LEGAL DESCRIPTION:
2. 1 r?, , "�" lam!
OWNER PHONE PHONE
3. S
PERMIT NUMBER_ -7
MAI/LING ADDRESS
1-7h
ZIP
Actual Set Backs in Feet to.
North South
kas T West
CQNTRACTOR
LICENSE EXPIRES
O
Size of reel
Zo eClassificato
Residential
6Y
Commercial ❑
4.
A DRES
P
CrI4s
TypeC9On
�J
Occupancy
Sprinklered
❑Yes El No ❑Req'd.
L
�-1V
ZO-
DESIGNER
PHONE
New Const. Valuation I I
Remodeled Valuation
Total Bldg. Floor Area
5
ADDRESS
ZIP
Main Floor
Upper Floors
Garage/Storage
Greenhouse
Fin. Basement
Unfin. Basement
CHANGE OF USE FROM
TO
Cover Deck
Uncv. Deck
6.
/
No. Baths
No. Floors
No. Fin. Rooms
No. Dwellings
TYPE 11 NEW El ALT.
PJ A D'N. 1-1 RPL. 1:1 MVE.
7. OFElOTHER
-7
WORK 26BLD. ❑ PLMB. ❑ MECH. ❑ M.H. ❑ POOL
Certifi. of Exempt.
Required
Yes L1 No❑
Number
or Variance
Received
Yes❑ No❑
DESCRIBE W RK /
I�i� (a
/
C� (���j��J
Shorelines/ Flood Hazard
Yes Not Applic. ❑
Plans Required L18
Received ❑
V L TION
SOURC
GAS
ELECTRIC
WATER
PUBLIC
SEWAGE/
SEPTIC 1
Ownership
FEES COLLECTED
9
;y n'�
11ti(O
LI
UTILITIES
PRIVATE ❑
SEWER 11
Public El Private
I her by 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 v
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 IN PECTIONS
Plumbing
SIGNATURE OF
APPLICATION
OWNER OR AGENT
DATE =��
Mach.
SPECIAL APPROVALS
SPECIAL COND IONS: (SEE REVERSE SIDE FOR NOTICE)
PRELIM. FINAL DATE
7�1 ( ( {�
"I Y'I L� e (!r (r w Ci `-'5K S�
Plan Check
Env. Health
/�
I 1 J
/A3
SEPA
Planning
Modular/
MFG. Home
Fire
a
Prevent.
O
Other (Specify)
W
Engineer
..1
Utilities
LL
TOTAL $
SEPA
WHEN MACHINE VALIDATED IN THIS SPACE,
Plans
PERMIT IS NONTRANSFERABLE
THIS BECOMES A PERMIT.
Exam.
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
Building
Tech.
t
IN 180 DAYS
0-j
4— 8 4 v7 '25 2 0' O 0
I
DATEED" PERMIT NO.
IX -1j
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W10
iky
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it