1984, 01-17 Permit: 84A-495 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. V- i31aT sTt Vis.
PARCEL NO.
LQI BLOCK SUBDIVISIO
AtNi
3. ° Li (\1s , n_754(.,
MAILING ADDRESS
1 (0
CONTRACT RLICE E EX IRE
4. P j s� CONS. q/2 -o l8 4
ADDRESS
N ,.,_- 1 9Pt 1F,uJA.
DESIGNER
5.
ADDRESS
CHANGE OF USE FROM
6.
PHONE
ZIP
PHONEof
ZI
Iro
PHONE
ZIP
TO
TYPE I.d'NEW 0 ALT. 0 AD' N. ❑ RPL. ❑ MVE.
7. OF
WORK I/BLD. ❑ PLMB. 0 MECH. ❑ M.H. 0 POOL '271 OTHER
2z 9-4 ----1011k010:
LEGAL DESCRIPTION:
SaAfinw K SulficRJtsiO)
Actual Set Backs In Feet to:
�7
t�
North (South 4J East I West -2- /
Residential GCI
Commercial
Size % /7-4%'
Zone C assWcation
TypeCrgnat.
upancy
Spr'nklered
❑Yes ❑No Req 'd.
New C,onst. al .
Remode ed Valuation
DESCRIBE WORK 6'N61. vA n r tv 5410
VALUATION
9.
SOURCE
OF
UTILITIES
GAS
ELECTRIC
Main Floor
Upper Floors
Cover Deck
No. Baths
Garage/Storage
Uncv. Deck
No. Floors
Certlf I. of Exempt.
or Variance
Shorelines/Flood Hazard
Yes ❑ Not Applic. ❑
WATER— -
PUBLIC LS
PRIVATE 0
SEWAGE
SEPTIC Er'
SEWER ❑
Ownership
Public 0 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 ordlnances 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 am u'-ff��
DAPTEICATION //
SPECIAL APPROVALS'
PRELIM. FINAL DATE
Env. Health
Planning
Fire
Prevent.
Engineer
Utilities
'4'71
SEPA
Plans
Exam.
Building
Tech.
SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
7ltG 1 iPPf--NCE T niottep 52,cm
S, Ica V%� es ilk C E yz .13107 011 pc,yE
PERMIT IS NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
Total Bldg. Floor Area
Greenhouse
Fin. Basement
No. Fin. Rooms
U I.2'4Basement
No. Dwellings
Plans Required ❑
Received ❑
FEES COLLECTED
Building
Plumbing
Mech.
Plan Check
SEPA
Modular/
MFG. Home
)
Other f-
TOTAL $
PERMIT NUMBE
CQ
4jfT[�11-52
02* *5000
35,3-
01-13-84
2 6479,
*89.00
*89.00
*000
a ./1='
1-17-R4
6.479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DA
TE7ESUE1)" 7 8
PERMIT Ng. 9' 5 z * 1 3 9. 0 0 4°O AL
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