1984, 04-05 Permit: 84A-2968 ResidencePLAN 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
STREET ADDRESS
1. c . 3°1 1 I UJOOP RJJ FF C�
PARCEL NO. 323-1 `, S
LO,T
2.
BLOCK
SUBDIVISION L ��
? G SP- AL2
3.
OWNER
N R . r Ow-. cG
PHONE
MAILING ADDRESS .
6:01_12f 1 201342
4.
CONTRACTOR / F'' r
ADDRESS
DESIGNER
5.
ADDRESS
LICENSE EXPIRES
CHANGE OF USE FROM
6.
PHONE
4+Co4, -031
ZIkt 25
LEGAL DESCRIPTION:
PHONE
ZIP
PHONE
ZIP
TO
TYPE ANEW ❑ ALT. ❑ AD' N. ❑ RPL. ❑ MVE.
7. OF ❑OTHER
WORK BLD. ❑ PLMB. ❑ MECH. El MECH. ❑ POOL
Actual Set Backs in Feet to:
North [South 3y
[East ZO I1
West
Size of Parcel
l�5' X 5h 124)46
Type est. OcApanc
N Const. V uation
sa
Iain Flppr O t
I
Zone=5 .
Residential G'S..
Commercial 7
Spr'nklered
❑Yes ❑No Req 'd.
Remodeled Valuation
UpRer Floors
Garage/ S.toragel
7
Total Bldg. Floor Area
Cover Deck
No. Baths
Uncv. Dec
1
No. Floors
2
Fin. Basement
Greenhouse
No. Fin. Rooms
7
Unfin. Basement
12.31 fl.
No. Dwellings
Certifi. of Exempt.
or Variance
Required Yes❑ No❑
Received Yesi_ No: '
Number
8.DESCRIBE WORK / 1 ! CICYVI
IVY
J nSS1 C7 / ? Tp
2.
VALUATION
9.
SOURCE
OF
UTILITIES
GAS
ELECTRIC
Shorelines/Flood Haza d
YesL NotApplic. E
WATER
PUBLIC $
PRIVATE U
SEWAG
SEPTIC
SEWER❑
Ownership
Public ❑ Privateg
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 / APPLICATION G .
OWNER OR AGENT—`�J - DATE
SPECIAL CONDITION'SOSEE REVERSE SIDE FOR NOTICE)
SPECIAL APPROV/
PRELIM. FINAL DATE
Health
Planning
Fire
Prevent.
✓'Engineer
Utilities
5E•
SEPA
Plans
Exam.
Building
Tech.
4_/74t,
PERMIT IS NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
Plans Required'g
Received PC
FEES COLLECTED
Building
Plumbing
Mech.
Plan Check
SEPA
Modular/
MFG. Home
Other (Specify)
TOTAL $
PERMIT NUMBER Q
*41800
*418.008
*000
03-22-84
6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATE ISSUEr. 5 —
PERMI720.6. 8 z * 4 1 8. D 0 T-0TAL