1984, 03-21 Permit: 84A-2446 Residence PLAN NUMBER APPLICATION/PERMIT . PERMIT NUMBER
-504- SPOKANE COUNTY - DEPARTMENT OF BUILDING & SAFETY 5414 -Z444'
NORTH 811 JEFFERSON /SPOKANE,WASHINGTON 99260/(509)456-3675
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
STREETADDRESS PARCEL NO.
1. - j?a , 'P t1&• o~�t-52-- 0S03.—
LOT BLOCK SUBDIVISION LEGAL DESCRIPTION:
2. ..`- �'LL_ ---- ,6970j.1 .
OWNER P ON PHONE
3.
iirn- .1�' "I5E)I
MA NG TRESSt I � � Zlp w GActual Se Backs in!eet to:
4-0 South [East 4 -v I West
4. CONZRACjO�j LICENSE EXPIRES PHONE/1� Si Parcel I Zope Classier cat't1o�n - Residential
o y
ADDRESS IP�y ZIP T � u yCIfe) /�1/-t -�Sprrriinklered
YPe ❑Yes 0 N ❑Req'd.
DESIGNER PHONE New nst.Valu do Remodeled Valuation Total Bldg.Floor Area
5. i 6 y
ADDRESS ZIP Majp plpor Upper Floors GaragelSto_rag@ Greenhouse
CHANGE OF USE FROM TO Cover Deck Uncv.Deck - Fin.Basement Unfin.Basement
No.Baths No.Floors No.Fin.Rooms No.NEDllings
7 TYPE W ❑ ALT. ❑ AD'N. ❑ RPL. ❑ MVE.OF ❑ OTHER 1l CO
I
WORK BLD. ❑ PLMB. 0 MECH. ❑ M.H. ❑ POOL Certifi.of Exempt. Required Yes No❑ Number
or Variance Received Yes No jjj
DESCRIBE RK W Shorelines/Flood Hazard Plans Required
8. b Yes❑ Not Applic.IIReceived.
VALUATION SOURCE GAS ELECTRIC WATER SEWAGE/ Ownership f FEES COLLECTED
9. OF PUBLIC SEPTIC D Public❑Privater
UTILITIES PRIVATE❑ SEWER❑
I hereby certify that I have read and examined this application and have read the " ICE" provisions included on
reverse side, and know the same to be true and correct. All provisions of laws and o'11"=hoes governing this type of Building
work will be complied with whether specified herein or not. The granting of a etercnitdoes not presume to give au-
thority to violate or cancel the provisions of any other state or local law reguIatiotdonstruction or the performance
of construction.SEE REVERS..DE FOR REQUIRED INSPECTIONS Plumbing
SIGNATURE OF III 41, .„
OWNER OR GENT -� ATE e,.
e,. Mech.
SPECIAL APPROVALS SPECIAL NDITIONS:(SEE REVERSE SIDE FOR NOTICE) 1
PRELIM. FINAL DATE Plan Check
Env.Health
SEPA
Planning
.'" Modular/
s' MFG.Home
Fire d
Prevent.
0
Engineer Other(Specify) W
hZ-6 417/76With
Utilities /24_ \ / � L�12 33 L
SEPA 7/9V TOTAL $
PERMIT IS NONTRANSFERABLE WHEN MACHINE VALIDATED IN THIS SPACE,
Plans THIS BECOMES A PERMIT.
Exam. IS NULL AND VOID IF WORK HAS NOT COMMENCED •
Bucking � 1 IN180DAYS @3 21 - 84 2NO.4462 *33400 ° �
DATE ISSUED PERMIT TOTAL