1984, 10-18 Permit App: 00002879 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. 4.O G �nlCCab�tzr:� r
LOT 1 BLOCK
2. S I
SUBDIVISION
�i C�►.3 : e—e:,C4. 1a-1.14 1 c D CC t 0 fv
OWNER
3.-0.1%,\) to 73 rktv,r,�rn
MAILING ADDRESS
PHONE PHONE
ZIP
CONTRACTOR LICENSE EXPIRES PHONE
4. (cAz-vx 7Z-7 o "15 C,6c2t<+cu t2s 4e4--CL1 l
ADDRESS ZIP
Cs4-r4 C'CX2C1.
DESIGNER
5.
ADDRESS
CHANGE OF USE FROM
6.
PARCEL NO.
5 -2 -S44 --2i )S
LEGAL DESCRIPTION:
Actual Set Backs in Feet to:
North i? 'South -Z.,.
East
Size of Parcel
%OC) A t
PHONE
ZIP
TO
TYPE @V EW ❑ ALT. C AD' N. ❑ RPL.
7. OF
WORK BLD. ❑ PLMB. ❑ MECH. ❑ M.H.
❑ MVE.
❑ POOL
❑ OTHER
Type Const.
Occupancy
R3) 7.44'1
ew Const. Valuation
V4' Ser5,1VS
West
Zone Classification
Residential K7
Commercial E
Sprinklered
❑Yes ❑No ❑ Req 'd.
Remode ed Valuation
Main Floor Upper Floors Garage/Storage
V-4440 — 457
Cover Deck
No. Bath
Certifi. of Exempt.
or Variance
Uncv. Deck
"LCuC-3
No. Floors
DESCRIBE WORK
8. OF iVC.F.
VALUATION
9.
SOURCE
OF
UTILITIES
GAS
ELECTRIC
Total Bldg. Floor Area
Greenhouse
Fin. Basement
No. FirRooms
Required YesE NOY'
Received Yes No
Shorelines/Flood Hazard
Yes Not Applic. ❑
WATER./
PUBLIC ri
PRIVATE ❑
SEWAGE
SEPTIC
SEWER 0
Ownership
Public 7 Private I2/
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
OWNER OR AGENT - ` a. �-"` DATE x �" 2 f
SPECIAL APPROVALS
PRELIM. FINAL DATE
Env. HeaCt
Planning
Fire
Prevent.
,Engineer
Utilities
SEPA
SPEAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
LLLOw - ./El,i?t-
• Plans
Exam1'
.'
Building
Tech.
1. CY.)
PERMIT IS NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
Unfin. Basement
yip 3
No. Dwellings
Number
Plans RequiredV
Received P/
FEES COLLECTED
Building
Plumbing
Mech.
Plan Check
SEPA
Modular/
MFG. Home
44g. ac}
Other (Specify)
TOTAL $41
j
PERMIT NUMBER
02* *44800
*448006
A *000 n
245,06
03-21-84
2 6479
2 7Ct
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATE ISSUED
PERMIT NO. TOTAL
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