1984, 02-02 Permit: 84A-937 Residence PLAN NUMBER ` APPLICATION/PERMIT - PERMIT NUMBER
C-� , SPOKANE COUNTY — DEPARTMENT OF BUILDING &SAFETY E 4 'cV37
NORTH 811 JEFFERSON/SPOKANE,WASHINGTON 99260/(509)456-3675
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
STREET ADDRESS PARCEL NO.
1. 5. 33c3 vvo O p P FF RO N) 3251,/—Z 303
LOT BLOCK SUBDIVISION LEGAL DESCRIPTION:
2. 3 I POND o'A 6-TJ-1 A`AD-
OWNER PHONE PHONE
3. MAT'TNvq...y CONST. R21-2Yiq
MAILING ADDRESS` ZIP Actual Set Backs in Feet to: '
s', o - c APM Rd./ (ZCAD E R1�eWACK£.S `IR'o/6 North 3.5 I !South /5j f [East I West 2 S
CONTRACTOR LICENSE EXPIRES PHONE Size of Parcel Zone Classification Residential 1
4. S/h'lnk_ los- 16-74 651 )./es- , S/, i F/lm f C Commercial❑
ADDRESS ZIP Type Const. Occupancy Sprinkler
V—hl g-3 ❑Yes ❑No ❑Req'd.
DESIGNER PHONE Niw Const.Valuation Remodeled Valuation Total Bldg.Floor Area
5. . .1 al144'07 5- /)�q
ADDRESS ZIP Main Fl Upper Floors Garage/Stora I Greenhouse
13 g6 /2,66 5z 'Y
s. CHANGE OF USE FROM TO Cover Deck Uncv.DeckO Fin.Basement Unf in.Basement
-- /366
No.Baths No.Floors No.Fin.Rooms No.Uyellings
TYPE (K'f1EW El ALT. El AD'N. El RPL. El MVE. Z., 1
7 WORK Cf'BLD. ❑ PLMB. El MECH. ❑ M.H. El POOL ❑ OTHER Certifi.of Exempt. Required Yes❑ No❑ Number
or Variance Received Yes❑ No❑
DESCRIBE WORK Shorelines/Flood Hazard Plans Required❑
8. Rim 5 HmNC +—c-,slNRAq E. U t 1pEK.'Dec A-nil citeD Yes❑ Not Apollo.❑ Received ❑
VALUATION �SODURCE GAS ELECTRIC PUBLIC WATER SEWIAC❑ Ownership FEES COLLECTED
9. JTILITIES PRIVATE❑ 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 51 ao
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 provisi;, s of any other state or local law regulating construction or the performance
of construction.SEE REVERSE SID• OR REQUIRED I -ECTI• S Plumbing
SIGNATURE OF i, APPLICATION
OWNER OR AGENT ' ,f `i ./Z.,,,,e,�—.ult../ DATE Mech.
SPECIAL APPROVALS SPECIAL CONDITION'. (S E EVERSE SIDE FOR NOTICE)
PRELIM. FINAL DATE 601 Kik) Plan Check
Env.Health
Ur+�j /�I - �J v CV itp SEPA
Planning
Modular/
MFG.Home
Fire
Prevent. p-
O
Engineer
�z� 1i47
Other(Specify) W
—J
Utilities 00 ii:TOTAL $ --
SEPA
WHEN MACHINE VALIDATED IN THIS SPACE,
Planskl PERMIT IS NONTRANSFERABLE THIS BECOMES A PERMIT.
Exam. 0—e (1- PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
Building IN 180 DAYS "_" ''A
Tech. (� [�
DATL-IS�UE� 2 -
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