1984, 02-14 Permit: 84A-1179 AddiitonPLAN NUMBER
Cartifi.ofExempt.
APPLICATION /PERMIT PE MWMBER
Yes❑ No❑
SPOKANE COUNTY - DEPARTMENT OF BUILDING & SAFETY _ 17
WORK
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
Received
APPLICANT: COMPLETE NUMBERED SPACES —PRESS HARD TO MAKE 3 COPIES
STREETADDRESSPARCEL
NO.
Shorelines/ Flood Hazard
Plans Required
2 LOT
BLOCK
fSUBDIVISIONVSI
Yes Not Applic. ❑
r
LEGAL DESCRIPTION: & r �.
VALUATION
9
SOURCE
GAS
�f D
WATER/
PUB IC.i�
0�
Q `moo f l�()I P3, JI -2��
"F'\
Ownership
OWNE_ R t� �
,ADDRESS
FEES COLLECTED
PH N
PHONE
PRIVATE ❑
SEWER ❑
I Public ❑ Privat
M ENGNG
ZIP
Actual Set Backs in Feet to:
Zj' 7r �✓
a y others to or local law regulating construction or the performance
of construction. SEE REV E S DE R E UIR PECTIONS
Plumbing
North South East West
APPLICATION j�
COdjR9CTOR
OWNER OR AGENT
LICENSE EXPIRES
Mach.
Size o�f Pl i ;C
I Zqne.Classificali
Bamercial
4.
❑
AD ESS 0
dif
3
Ty
V
Ocupa
Sprinklered
Dyes ❑No ❑Req'd.
DESIGNER
HONE
New Co u�tion
Remodeled Valuation
Total Bldg. Floor Area
5.
ADDRESS
ZIP
C F
Upper Floors
Garage/Sto gge�
Greenhouse
CHANGE OF USE FROM
TO
coverbeciZ
Uncv. Deck
Fin. Basement
Unf In. Basement
7. OF PE ❑ N ❑ALT. �AD'N. ❑RPL. 1:1 MVE. ❑OTHER
No. Baths
No. Floors
No. Fin. Rooms
No. Dwellings
LD. E]PLMB. ❑ MECH. ❑ M.H. ❑ POOL
Cartifi.ofExempt.
Required
Yes❑ No❑
Number
WORK
or Variance
Received
Yes❑ No❑
DES E�(V9RK
8•
Shorelines/ Flood Hazard
Plans Required
Yes Not Applic. ❑
Received
VALUATION
9
SOURCE
GAS
ELECTRIC
WATER/
PUB IC.i�
SEPTIC E
Ownership
FEES COLLECTED
UTILITIES
PRIVATE ❑
SEWER ❑
I Public ❑ Privat
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 specifi herein or not. The granting of a permit does not presume to give au-
thority to violate or cancel the pr visions
a y others to or local law regulating construction or the performance
of construction. SEE REV E S DE R E UIR PECTIONS
Plumbing
SIGNATURE OF
APPLICATION j�
OWNER OR AGENT
DATE [-
Mach.
SPECIAL APPROVALS
PRELIM. FINAL DATE
Env. Health
P. L 1410
Planning
Prevent
Utilities
SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
LA G �� IG -Z i Plan Check
SEPA
Modular/
MFG. Home
Plans �/ PERMIT IS NONTRANSFERABLE
Exam. l `' PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
Building I �'jjY I /I XOI IN 180 DAYS
Tech. �� I
Other (Specify)
- - ---- ----- --
TOTAL $
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
I jj �7 n
DATEVS�ED� 4 L' PERMITiIA. /• 9
* 8 L: 0 O #olrAL
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