1984, 04-05 Permit: 84A-2971 ResidencePLAN NUMBER
APPLICATION!/PERMIT
SPOKANE COUNTY i' DEPARTMENT OF BUILDING & SAFETY
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
STREET ADDRESS
1. , �-v (�}--
2.
LOTI
S BLOCK
�
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
SUBDIVISION
OWN R Nil elss.e,7 PI-jONE
3. MAI
NING ADDRESS- j1i6iq Nf+j'-r61�
COONNT. C
4.
ADDRESS
•�
PHONE
PARCEL NO.
LEGAL DESCRIPTION:
LICENSE EXPIRES
DESIGNER
5.
ADDRESS
CHANGE OF USE FROM
PHONE
ZIP
PHONE
ZIP
TO
TYPE ❑ ALT. E AD' N. ❑ RPL. ❑ MVE.
7. WORK BLD. E PLMB. E MECH. ❑ M.H. ❑ POOL ❑ OTHER
Actual Set Backs in Feet to:
North L� ,' (South 2 5 [East 1 West
Size ofpalce
I�(
Type
u
DE IB WOR
SOURCE GAS ELECTRIC WATER SEWAGE/
OF PUBLICS SEPTIC
UTILITIES PRIVATE ❑ SEWER ❑
VALUATION
9.
Zort,e Clasgif}catipn
Residents
Commerc al f
Spr'nklered
❑Yes ❑No ❑Req'd.
New Const. Valuati n Remodeled Valuation
Main FI.. Upper Floors GaragejStorage
Cover Deck
No. Baths
Uncv. Deck
No. Floors
Certifi. of Exempt.
or Variance
Total Bldg. Floor Area
Greenhouse
Fin. Basement
No. Fin. Rooms
Required Yes ❑ No❑
Received Yes❑ Non
Shorelines/Flood Hazard
Yes ❑ Not Applic. ❑
Ownership
Public =11 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 ap�YY other state or local law regulating construction or the performance
of construction. SEE REVSIDE 6OR RUIRED INSPECTIONS
SIGNATURE OF
OWNER OR AGEN
SPECIAL APPROVALS✓
PRELIM. FINAL DATE
Env. Health
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
3
l2 -
APPLICATION.
DATE
SPECIAL CONDITION • (SEE REVERSE SIDE FOR NOTICE)
e4.1 -r: t-Ic L.447.42-1 rU c.30'jL /
PERMIT IS NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
Unfin. Basement
No. Dwellings
Number
Plans Required ❑
Received ❑
FEES COLLECTED
Building
Plumbing
Mech.
Plan Check
SEPA
Modular/
MFG. Home
Other (Specify)
TOTAL $ 411
PERMIT
02* *41500
*415.006
A *0.00 n
21392
03-13-84
6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATE4S9 EcO 5 8 4
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