1984, 02-27 Permit: 84A-1630 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
STREETADDRESS PARCEL NO.
LOT I BLACK SUBDIVI ION LEGAL DESCRIPTION:
2.
Z. I
OWNm y_._-, f�, , I PHONE PHONE
MAILING ADDRESS �,� Ir�v Z Actual Set Backs in Feet to:
1E-7.Tk6 ��l�r��7� moi!? North South East West
CO T A T R LIC NSE EXPIRES H E / Size of Parcel ne Classifi tin Residential
i
4. p �j � 5� . � Commercial ❑
AD KESS , tM Type Co st. upancy Sprinklered
❑Yes ❑No ❑Req'd.
DESIGNER PHONE New Const. Valuation Remodeled Valuation Total Bldg. Floor Area
5.
ADDRESS ff
Main Floor Upper Floors Garage/Storage Greenhouse
s. CHANGE OF USE FROM 70 --
Cover Deck Uncv. Deck Fin. Basement Unfin. Basement
7 OFPE 0 EW ALT. ElAWN. El RPL. 1:1MVE. ❑OTHER No. Baths No. Floors No. Fin. Rooms No. Dwellings
WORK F BLD. ❑ PLMB. ❑ MECH. ❑ M.H. ❑ POOL Certifi.ofExempt. Required Yes❑ No❑ Number
or Variance Received Yes❑ No❑
DESGRIIIEWORK Shorelines/ Flood Hazard Plans Requir
8• FA�b r1G✓I yes Not Applic. ❑ Received
VALUATI N OURCE GAS ELECTRIC WATER SEWA E Ownership
9 8� OF PUBLIC SEPTIC Public ❑Private FEES COLLECTED
UTILITIES PRIVATE ❑ SEWER ❑
I h eby 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 �o
work will be compiled with whether specified herein or not. The granting of a permit does not resume to Building
p p g g p p give au-
thority to violate or can el the provisions of any other state or local law regulating construction or the performance
of construction. SEE REVERSE SIDE FOR REOUI ED INSPECTIONS Plumbing
SIGNATURE OF APPLICATION
OWNER OR AGENT L0111 ti DATE 2 Mach.
SPECIAL APPROVALS SPiFIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
Env. Health
PRELIM. FINAL DATEAl CIO
�1
Planning
Fire
Prevent.
Utilities
SEPA
Plans PERMIT IS NONTRANSFERABLE
Exam. PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
Building�/� IN 180 DAYS
Tech. _
i
Plan Check
SEPA
Modular/
MFG. Home
Other (Specify)
15
TOTAL $
PEWIT NUMBER
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
0 2x=27-8�� 153.Oz *138,OOa�
DATE ISSUED PERMIT NO. TOTAL
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