1984, 03-29 Permit: 84A-2718 Special InspectionPLAN 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
1.
STREET ADDRESS
LOT
2.
BLOCK SUBDIVISION
3
OWNE
j'1-1-
PHONE
PHONE
PARCEL NO.
LEGAL DESCRIPTION:
MAILING ADDRESS
�._ ,
. lQ "VI G7IL+vV
4.
CONTRACTOR
LICENSE EXPIRES
f
Actual Set Backs in Feet to:
North South
East l West
PHONE
Size of Parcel Zone Classification
Residential
Commercial TI
ADDRESS
ZIP
Type Const.
Occupancy
Sprinklered
❑Yes No ❑ Req 'd.
DESIGNER
PHONE
New Const. Valuation
Remodeled Valuation
Total Bldg. Floor Area
ADDRESS
CHANGE OF USE FROM
6.
ZIP
TO
TYPE ❑ NEW E ALT. O AD' N. ❑ RPL. ❑ MVE.
7. OF
WORK ❑ BLD. ❑ PLMB. ❑ MECH. ElM.H. ❑ POOL
THER
Main Floor
Upper Floors
Garage/Storage
Greenhouse
Cover Deck
Uncv. Deck
Fin. Basement
Unfin. Basement
No. Baths
No. Floors
No. Fin. Rooms
No. Dwellings
Certifi. of Exempt
or Variance
Required Yes❑ No❑
Received Yes❑ NoH
Number
DESCRIBE WORK
8 .
VALUATION
9.
SOURCE
F
UTILITIES
GAS
ff 9
ELEC IC 1 WATER SEWAGE
PUBLIC ❑ SEPTIC ❑
PRIVATE ❑ SEWER C
Shorelines/Flood Hazard
Yes NotApplic. C
Ownership
Public 0 Private 0
I hereby certify that I have read and examined this appl cation 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
work will be complied with whetEr 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 REVERSEFDR-AECIDIR9 INSPECTIONS
SIGNATURE OF
OWNER OR AGENT =T=- .�
APPLICATION
DATE 3-._.9
SPECIAL APPROVALS
PRELIM. FINAL DATE
Env. Health
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PERMIT IS NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
Plans Required
Received
FEES COLLECTED
Building
Plumbing
Mech.
Plan Check
SEPA
Modular/
MFG. Home
Other (Specify) L -
TOTAL $
PERMIT NUMBER
7,71 e,
02* *2000
*20.006
A *C00
271.72
03-29-84
6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATE ISSUED Cf PERMIT2NZ.1. 8
z *200001AL