1984, 03-01 Permit: 84A-1752 Addition PLAN NUMBER APPLICATION/PERMIT PERMIT NUMBER
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SPOKANE COUNTY - DEPARTIVIENT OF BUILDING & SAFETY 04.4 — X75 1
NORTH 811 JEFFERSON/SPOKANE,WASHINGTON 99260/(509)456-3675
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
STREET ADDRESS PARCEL NO.
1. . 2.000 qCIewORill
LOT BLOCK SUBDIVISION LEGAL DESCRIPTION:
2.
OWNER ry\I P.-- A-F�/I t. Pz"Jl:ION5 PHONE
3. � -
—073
Actual Set Backs In Feet to:
MAILINGADDRESS _ ZIP GI f-nc North ((Sr'South (j'T [East .4 t I West 'x(C--.
CONTRACTOR 51 X.
,LICENSE EXPIRES PHONE Size of Parcel Zone Classification Residential
Commercial❑ : / v; (. i, v'
4. ADDRESS ZIP Type_ Con . Occ�pa/cyz ❑Yes Spr❑Nored ❑Req'd.
DESIGNER PHONE N Const.Val alio Remodeled Valuation Total Bldg.Floor Area i`
s. 67(L marm� 4 0 _ , ;
ADDREss '8� ' 1,15W--
ZIP i F_loorS Upper Floors Garage/Storage Greenhouse
l a
J i
CHANGE OF USE FROM TO Cover Deck Uncv.Deck Fin.Basement Unfin.Basement
6.
No.Baths No.Floors No.Fin.Rooms No.Dwellings
TYPE ❑ NEW ❑ ALT. D'N. ❑ RPL. ❑ MVE.
7. OF ❑ OTHER
WORK`' LD. 0 PLMB. ❑ MECH. ❑ M.H. ❑ POOL Certifi.of Exempt. Required Yes❑ No❑ Number
or Variance Received Yes❑ No❑
8.
DESCRIBE E WORK ,c. /��� {O t `� 101
Shorelines/Flood Applic.HazDd Plans Required D
Received ❑
�1 f� /1/4001110N L r
VALUATION SOURCE GAS ELECTRIC WATER SEWAG Ownership FEES COLLECTED
9. OF PUBLIC❑ SEPTIC Public❑Private
UTILITIES PRIVATE❑ SEWER❑ S,
I hereby certify that l 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 j 1- ®✓
work will be complied with whether specified herein or not. The granting of a permit does not presume to give au- Building
thority to violate or cancel the rovisions of any other state or local law regulating construction or the performance
of construction.SEE REVERS DE FO OU RED INSPECTIONS Plumbing
SIGNATURE OF ` d7,h./ DATEAPPLICATION �18 Mech.
OWNER OR AGENT f/
SPECIAL APPROVALS SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
Plan Check
PRELIM. FINAL DATE
/ c Health �
V {` i4, qi SEPA
Planning Modular/
Fire MFG.Home a a
Prevent. O z
Engineer Other(Specify) W
J
Utilities / i os-
TOTAL $ (Q
SEPA
WHEN MACHINE VALIDATED IN THIS SPACE,
Plans PERMIT IS NONTRANSFERABLE THIS BECOMES A PERMIT. •
Exam.
Building / PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
/ //. % IN 180 DAYS ..
Tech. % /i/ 0 3 oxrgi wEg f :g.Q Np... 2
* OTOTAL
I2 6I, OOaI
E - - i
Z
171
3
167 I
..Q I
o