1984, 01-13 Permit: 84A-373 Insert PLAN NI::,BER APPLICATION/PERMIT PERMIT NUMBER
SPOKANE COUNTY — DEPARTMENT OF BUILDING & SAFETYA _ . 73
NORTH 811 JEFFERSON/SPOKANE,WASHINGTON 99260/ (509)456-3675
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
1 STRF A r s`3 c - r.L -r, PARCEL NO.
LOT BLOCK SUBDIVISION LEGAL DESCRIPTION:
2.
OWNERPHONE PHONE
3. 0'f b vlveti ,.A -:3'33?
MAILING ADDRESS ) _ /1- ZIP Actual Set Backs in Feet to:
/.vim_ Uiet.t)L J /• North !South East I West
4. ��TRACTOR n LICE Sr,IRES PHONE Size ofParcel Zone Classification Residential
7 i /air,, / / h��s y�� Commercial❑
A?DR O d4 7 .9f e< 1 `�a/C�-!l .966 7-Wee Type Const. Occupancy ❑Yes Spr❑Nored ❑Req a.
IGNER a C P ONE New Const.Valuation Remodeled Valuation Total Bldg.Floor Area
DRESS ZIP Main Floor Upper Floors Garage/Storage Greenhouse�7 ria 7 yG�� ,
CHANGE OF USE OM TO Cover Deck Uncv.Deck Fin.Basement Unfin.Basement
6.
No.Baths No.Floors No.Fin.Rooms No.Dwellings
TYPE ❑ NEW ❑ ALT. ❑ AD'N. ❑ RPL. ❑ MVE.
7. OF ❑ OTHER
WORK
El BLD. El PLMB. ❑ MECH. ❑ M.H. ❑ POOL aVari.ofE Exempt. Required Yes❑ No❑ Number
Received Vest: No❑
ESCR RK^� '- (� Shorelines/Flood Hazard Plans Required❑
C�f;(.Q2'YL, �K x21:44� id2Yes❑ N000d H c.❑ Received ❑
VALUATION SOOUFCE GAS ELECTRIC PUBLIC WATER SEE TIC O Ownership FEES COLLECTED
9• UTILITIES PRIVATE D SEWER❑ Public❑Private❑
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 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._VERSE SIDE FOR REQUIRED INSPECTIONS Plumbing
' / / APPLICATION
SIGNATURE OF
OWNER OR AGENT +-psi• ', ••• • DATE �� Mech.
SPECIAL APPR• ALS / SPECIAL CONDITIONS: (SEE REVERSEaaSIDE FOR NOTICE)
PRELIM. FINAL DATE ?)14-t11-6L
/] Plan Check
Env.Health g7LLL: V /� t ��
�j.. ' /,1 Li r r e i SEPA
Planning // Modular/
MFG.Home
Fire d
Prevent. O
C.)
Engineer Other(Specify) im
J_
Utilities LL
TOTAL $"��
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
Building IN 180 DAYS (('I F., o 'r 0 o
Tech. / 0 DATEfi UEI i� —° 4 PERMIT N0.7. 5'z * 2 �. 0 TOTAL