1984, 03-20 Permit: 84A-2401 Addition PLAN NUMBER _ APPLICATION/PERMIT PERMIT NUMBER,
SPOKANE COUNTY — DEPARTMENT OF BUILDING & SAFETY &q' -.2'4-(3 1
PiNORTH 811 JEFFERSON/SPOKANE,WASHINGTON 99260/(509)456-3675
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
STREET ADDRESS PARCEL NO.
1. . 2Co)4 SAL-rccc -z-754-2.- Ot Th
LOT BLOCK SUBDIVISION LEGAL DESCRIPTION:
2. I% 1 , t c -v `'g,,,2—K
OWNER PHONE PHONE
3. S c,p.►..) k .1..L- QZ4r"e,(C4
MAILING ADDRESS ZIP Actual Set Backs in Feet to:
VC
e• . . 4— �FiC-ttom�E, g
. - q..ZCC North •Z5
South LEast 10 J I West
CONTRACTOR LICENSE EXPIRES PHONE Size of Parcel Zone Classification 3 C�Residential
at}►MZ C44->c At) P+'2)X. '; -wry Commercial❑
4. ADDRESS ZIP Type Const. Occupancy Sprinklered
SAMLY — -N YAA ❑Yes 0 N ❑Req'd.
DESIGNER PHONE N Const.Valuation Remodeled Valuation Total Bldg.Floor Area
-T-3.4.5.4. 7C..
5. ADDRESS ZIP Main Floor Upper Floors Garage/Storage Greenhouse
CHANGE OF USE FROM TO Cover Deck Uncv.Deck Fin.Basement Unf in.Basement
6.
No.Baths No.Floors No.Fin.Rooms No.Dwellings
TYPE ti6EW 0 ALT. 0 AD'N. 0 RPL. 0 MVE.
7. OF ❑ OTHER
WORK BLD. ❑ PLMB. ❑ MECH. ❑ M.H. ❑ POOL orVarianExempt. Required Yes❑ No❑ Number
Received Yes Non
DESCRIBE WORK "C Shorelines/Flood Hazard Plans Required❑
8. 4 I--01.2- 0%03 :-r.c (ff z4 X..4) Yes❑ Not Applic.❑ Received ❑
VALUATION SOOURCE GAS ELECTRIC WATER PUBLIC❑ SEPTIC I Ownership FEES COLLECTED
9. 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 Building 6+CC
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 REV,.), SIDE FOR REQUIRE''INSPECTIONS Plumbing
SIGNATURE OF ., I. APPLICATION�/j// / !l'�.
OWNER OR AGENT l .� —�� / DATE l �/Z Mech.
SPECIAL APPROVALS SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
Plan Check
PRELIM. Fl AALL��/s• E
Env.Health _40
4 :%_e/e)4 SEPA
Planning CJ Modular/
4 MFG.Home
Fire a-
Prevent. v
Engineer Other(Specify) ttJ
J
L
Utilities
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 ((�� a. /�
Building
ech^g 91)
/ IN 180 DAYS DATE�-ISSUE2 O -8 4 PERMI129.O. 1 z * 5 4. 0 0 RdTAL
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