1984, 01-17 Permit: 84A-516 Remodel PLAN NUMBER APPLICATION/PERMIT PERMIT NUMBER
SPOKANE COUNTY — DEPARTMENT OF BUILDING & SAFETY 4 - S'I
y NORTH 811 JEFFERSON/SPOKANE,WASHINGTON 99260/(509)456-3675
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
STREET ADDRESS PARCEL NO.
1. _ (80I
�f 9 ! \1064\1r-itIN fl- 0
LOT BLOCK SUBDIVISION LEGAL DESCRIPTION:
2. 1 1 P01,11711,4 PI is F.(1?- 1.� App .
OWNER
AIZ' ( .i 'IZ—.)1 PHONE ^2-°e
3. `?y 3
MAILING ADDRESS ZIPActual Set Backs in Feet to:
North 'South East I West
4. C{'L� U�f ( (w L & < —17�_ Size of Parcel Zone Classification Residential❑
f/- i !t Commercial❑ s, , x
ADDRESS(� �y/ �r /�, ZI �7 Type Const. Occupancy Sprinklered
rc, 0 .. ez x l e tcl 2 1 UlKpo\l - t WA , cl 9 G�i ❑Yes ❑No ❑Req'd. k J C
DESIGNER PHONE New Const.Valuation Remodeled Valuation Total Bldg.Floor Area f'
5. ADDRESS ZIP Main Floor Upper Floors Garage/Storage Greenhouse I.
CHANGE OF USE FROM TO Cover Deck Uncv.Deck Fin.Basement Unfin.Basement M
6.
No.Baths No.Floors No.Fin.Rooms No.Dwellings
TYPE El NEW ❑ ALT. El AD'N. El RPL. El MVE.
7. OF XOTHER
WORK El BLD. ❑ PLMB. El MECH. ❑ M.H. El POOL aVaziaExempt. Required Yes❑ No❑ Number
Received Yes❑ No❑
DESCRIBE WORK //��,��- �-�- / Shorelines/Flood Hazard Plans Required❑
8. ois ---rn Y`4p_F ry o Lt,l(\1�C..(t S: Yes❑ Not Applic.❑ Received ❑
VALUATION/ �2 SOURCE GAS ELECTRIC PIWATER SEWAGE Ownership FEES COLLECTED
c�+ ✓0 OF SEPTIC Public❑Private❑
UTILITIES PRIVATE❑ SEWER❑
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 6I :C�
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 REVER• : SIDE FOR REOUI- - ► INSPECTIONS Plumbing
SIGNATURE OF APPLICATION 1^ ! "7 fr
y
OWNER OR AGENT .- DATE l l C O L Mech.
SPECIAL APPROVALS SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PRELIM. FINAL DATE Plan Check
Env.Health
LjG 27j 'e I SEPA
Planning ( 0
Modular/
MFG.Home ).
Fire a
Prevent. a
Engineer Other(Specify) W
9 –J
Utilities /; I G 0 LL
TOTAL $ L
SEPA
WHEN MACHINE VALIDATED IN THIS SPACE,
Plans PERMIT IS NONTRANSFERABLE THIS BECOMES A PERMIT.
Exam. PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED rr, 77 L
Building
ech mg i ///7
y IN 180 DAYS DATEOSS.UED1 7 -8 PERMIT N�.1,6 5 * 6 1. 0 0 iO AL