1984, 04-19 Permit: 84A-3570 ReroofPLAN NUMBER
APPLICATION/PERMIT
SPOKANE COUNTY - DEPARTMENT OF BUILDING & SAFETY
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
1.
2.
APPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 3 COPIES
STREET ADDRESS
E kz.61Cv
LOT BLOCK SUBDIVISION
PARCEL NO.
OWNER
C , ,ra
MAILING ADDRESS
C— (2.0C%
CONTRACTOR
pyiC
4. ADDRESS
DESIGNER
5.
ADDRESS
PHONE
PHONE
ZIP
�Gzic,
LICENSE EXPIRES
PHONE
ZIP
PHONE
LEGAL DESCRIPTION:
Actual Set Backs in Feet to: E
North I South I East I West
Size of Parcel
Zone Classification
Residential fD/
Commercial
ryp_ onst.
Occupancy
7>
Sprinklered
EYes CNo ❑Req'd.
New Const. Valuation
mode ed Valuation
Total Bldg. Floor Area
ZIP
Main Floor
Upper Floors
Garage/Storage
Greenhouse
6.
CHANGE OF USE FROM
TO
Cover Deck
Uncv. Deck
Fin. Basement
Unfin. Basement
TYPE ❑ NEW
7. OF
WORK 'BLD.
8.
9.
DESCRIBE WORK
`52,€
ALUATION
23
❑ ALT. ❑ AD' N. 1 RPL.
❑ PLMB. ❑ MECH. ❑ M.H.
❑ MVE.
❑ POOL
❑ OTHER
No. Baths
No. Floors
No. Fin. Rooms
No. Dwellings
Certifi. of Exempt.
or Variance
Required
Received
Yes❑ NoCT
Yes❑ No❑
Number
ZG; t7 C- lvC,C
Shorelines/Flood Hazard
Yes, Not Applic. C
Plans Required C
Received E
SOURCE
F
UTILITIES
GAS
ELECTRIC
WATER
PUBLIC ❑
PRIVATE C
SEWAGE
SEPTIC ❑
SEWER ❑
Ownership
Public C 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 REVER$ESIDE FOR REQ 7JIRED INSPECTIONS
/
SIGNATURE OF
OWNER OR AGENT(
SPECIAL APPROVALS
PRELIM. FINAL DATE
177
APPLICATION //
< DATE '7 �/— t Y
Env. Health
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PERMIT
IS NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
FEES COLLECTED
Building
Plumbing
Mech.
Plan Check
SEPA
Modular/
MFG. Home
Other (Specify)
TOTAL $ 7C)
PERMIT NUMBER
L2* *2000
3569-
04-19-84
2 6479
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATE9SSUED1 9 -8 4
PERMITN. 70 5
*2 O,O OiO AL
a
O
W
—J