1984, 03-06 Permit: 84A-1874 ResidencePLAN NUMBER
APPL !CAT Oi % /PERM IT
SrOiCANE COUNilY ---- DEPARTMENT 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 W001)12-4-4;FI2 AP
PARCEL NO.
221 4 .-� log
LOT BLOCK
2. c.
SUBDIVISION
FttuP-.01.N 114 > OD .
LEGAL DESCRIPTION:
OWNER PHONE
3
MAILING A7D7 04 cnt u.Q5K/ ILL)w
4.
CONTRACTOR
PFJONE
AD RESS
-7U4 (aOL N R0
LICE E E PIRE
/0/15/E:)4 o? 2 .
PHONE
`lZE)-Cod
Actual Set Backs in Feet to:
North 7..-C) (South 2.0
Size of Parcel
ZIP
100 X I-‘
Coqst.
I� Occupancy
12
V�-3
Type
East 3 c i I West
Zone Classification
Residential 1K
Commercia
Sprinklered
❑Yes ENo Req 'd.
DESIGNER
5. ADDRESS
PHONE
CHANGE OF USE FROM
6.
ZIP
TO
TYPE 1 .NEW ❑ ALT. E AD' N. ❑ RPL. ❑ MVE.
7 OF 111 OTHER
WORK ,BLD. L PLMB. E MECH. E M.H. ElPOOL
NewConst. Valuation
Main Floor Upper Floors
1567 P
Remode ed Valuation
Total Bldg. Floor Area
Garage/Storage
S2 -e ';P
Greenhouse
Cover Deck
No. Baths
.3
Ungv. Deck
15 ter.
No. Floors
Fin. Basement
7 S
No. Fin. Rooms
s
Unfin. Basement
No. Dwellings
Certifi. of Exempt.
or Variance
Required Yes❑ No❑
Received Yes No❑
Number
8.
DESCRIBE WORK
Shorelines/Flood Hazard
Yes L: Not Applic.
Plans Required
Received �:
VALUATION
9.
SOURCE
UTILITIES
GAS
ELECTRIC
WATEL.
PUBLIC
PRIVAT ❑
SEWAG
1.
SEPTIC
SEWS ❑
Ownership
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
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
SIGNATURE OF
OWNER OR AGENT
SPECIAL APPRO» S
PRELIM. F L DATE
Env. Health
Planning
APPLICATION lj
DATE
SPECIAL CONS: (SEE REVERSE SIDE FOR NOTICE)
iv2e,*
Fire
Prevent.
v./Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
V.S.
C - Cao �D �C,C 175(9\
zpOl (Q01 12./(.0 s17:0t+s+si6D
P6
l//L/qk)
PERMIT IS NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
FEES COLLECTED
Building .41 Z
Plumbing
Mech.
Plan Check
SEPA
Modular/
MFG. Home
Other (Specify)
TOTAL $
PERMIT NUMBER
ia7+
02*
*4,12.00
*4.12.00
*0 00 0
130.0E
2-15-84
6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATIEJSUt 6 8 4
PERMITTNg.7 * 4 1 2, 0 0 ad AL
/I
Lor 9. 3LocK 1 ?oivpe1c,rm gDf�iTioN
GoLDEwcREsT CoA sTLvcT1&) Copia iuy
/00'
id
'i
1;*
%i%twA) Race 4l E v/T l oi)
/03
o
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