1984, 04-03 Permit: 84A-2860 AdditionPLAN NUMBER APPL ICAT ION /PERMIT
SPOKANE!;OUNTY — DEPAR-..AENT OF BUILDING & SAFETY
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
STREET ADDRESS
1. � , lob, -
PARCEL NO.
1 -7t5++ -
-7t5++ --LOT
LOT
BLOCK
SUBDIVISION
LEGAL DESCRIPTION:
2.
I
I
OWNER �
PH'
s
�
P ON /0 Q
3.
No. Fin. Rooms
(��
7 NOF ❑ ALT. Z AD' N. ElRPL. I]MVE.
❑ OTHER
MAILING ADDRESS
i 'i'
Actual Set Backs in Feet to:
WORK "LD. ❑ PLMB. ❑ MECH. ❑ M. H. ❑ POOL
North South Eas4-1 West
CONT CT R
LICENSE EXPIRES
PHONE
Size of Pa cel
'()o
'*
ZRM
Received
Residential
4.
8 DESCRIBE WORK
`��
?C 42
Plans Required
_
Commercial ❑
ADDRESS
ZIP
Type�n;t.
Occupancy
Sprinkjered
Dyes PRO ❑Req'd.
ELECTRIC
pUBL CR
SEPWTICG
Ownership
DESIGNER
PHONE
New Const. Va uation
I Remodeled Valuation
Total Bldg. Floor Area
PRIVATE ❑
SEWER ❑
Public ❑ Privatee
5.
provisions included on
reverse side, and know the same to be true and correct. All provisions of laws and ordinances governing this type of
ADDRESS
ZIP
Main Floor
Upper Floors
Garage/ Storage
Greenhouse
of construction. SEE REVERSE SIDE FOR REQUIRED INSPECTIONS
Plumbing
SIGNATURE OF �., I APPLICATION
OWNER OR AGENTlar-DATE
Mech.
CHANGE OF USE FROM
TO
Cover Deck
Uncv. Deck
Fin. Basement
Unfin. Basement
�
TYPE❑
No. Baths No.
Floors
No. Fin. Rooms
No. Dwellings
7 NOF ❑ ALT. Z AD' N. ElRPL. I]MVE.
❑ OTHER
WORK "LD. ❑ PLMB. ❑ MECH. ❑ M. H. ❑ POOL
Certifi.ofExempt .
Required
Yes❑ NOD
Number
or Variance
Received
Yes❑ No❑
8 DESCRIBE WORK
`��
Shorelines/ Flood Hazard
Plans Required
��
Yes❑ Not Applic. ❑
Received ❑
VALUATION
SOOUFCE
GAS
ELECTRIC
pUBL CR
SEPWTICG
Ownership
FEES COLLECTED
9•
I UTILITIES
PRIVATE ❑
SEWER ❑
Public ❑ Privatee
1 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
Building
work will be complied with whether specified herein or not. The granting of a permit does not presume to give au-
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 �., I APPLICATION
OWNER OR AGENTlar-DATE
Mech.
SPECIAL APPROVALS
SPECIAL CONDITIONS: (EE REVERSE SIDE FOR NOTICE)
PRELIM. FINAL DATE {
Env. Health P T- 1
Planning
Prevent.
Plans
Exam.
Z-�_
PERMIT IS NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
Plan Check
SEPA
Modular/
MFG. Home
Other (Specify)
TOTAL $
WHEN MACHINE VALIDATED IN THI
THIS BECOMES A PERMIT.
PE,ARMIT NUMBER��
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C
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DATE ISSuED4 - 0 3 - 8 4 PERMIT No. 2 8 60 z * 8 2, 4)oi4. I-
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