1984, 03-01 Permit: 84A-1771 AdditionPLAN 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.
,. 02ii UAB-�r'w 1-7 9f� -ZZ[�.
2 LOT I BLOCK SUBDIVISION LEGAL DESCRIPTION: OPP PL3 P.rOP Leo $L
O R N PHONE P ONEr 1 I �QQ 'F'r OF (%L) zay.Fir 'r—,Y N I o 7t Yb F -i
3.
MAILING ADDRESS ZIP Actual Set Backs in Feet to:
— North South G �• East 74-301 1 West G
CONTRACTOR
LICENSE EXPIRES
PHONE
Size of ParcelZone
/ ,
Classification
I
Residential
4.
('?Q
A16; _S'
Commercial 0
ADDRESS
ZIP
Type t.Occupy
Sprinklered
❑Yes ❑No ❑Req'd.
DESIGNER
PHONE
Const. Valuations
Remodeled Valuation
Total Bldg. Floor Area
5.
ADDRESS
ZIP
n Floor Upper
Floors
Garage/Storage
Greenhouse
CHANGE OF USE FROM
TO
Cover Deck
Uncv. Deck
Fin. Basement
Unfin. Basement
s.
TYPE ❑NEW ❑ALT. �AD'N. El RPL. ❑ MVE.
No. Baths No.
Floors
No. Fin. Rooms
No. Dwellings
7. WORK ^BLD. ElPLMB. ❑ MECH. ❑ M.H. 11 POOL ❑OTHER
OF
Certifi.ofExempt.
Required
Yes❑ No❑
Number
or Variance
Received
Yes❑ No r-1
8. DESCRIBE WORK 12 l �� �O h
Shorelines/ loop Hazard
Required El
Ham
0d
Yer❑
Received ❑
VALUATION
9
I SOURCE
GAS
ELECTRIC
TER
PUBLIC
SEWAGE
SEPT C_fi�
Ownership
FEES COLLECTED
UTILITIES
PRIVAT
SEWERR❑
Public ❑ Private
I hereby certify that I have read and examined this application and have read the "NOTICE"
provi§ions 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 specified herein or not. The granting of a permit does not presume to give au-
Building
thority to violate or cancel the provisions of any other state or local law regulating construction or the performance
of construction. SEE REVERSE SIDE FOR REQUIRED INSPECTIONS
Plumbing
SIGNATURE OF 4 APPLICATION /
OWNER OR AGENT DATE ! ?
Mech.
SPECIAL APPROVALS SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PRELIM. FINAL DATE
Env. Health
Planning
Prevent.
Utilities
Plans PERMIT IS NONTRANSFERABLE
Exam. PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
Building
Tech. IN 180 DAYS
� •2
Plan Check
SEPA
Modular/
MFG. Home
Other (Specify)
PERMIT NUMBER
171
Vo
TOTAL $ ✓
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
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DATE�SSUED" 1 PERMITLr . 7° c
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