1984, 03-08 Permit: 84A-1950 Residence PLAN NUMBER APPLICATION/PERMIT PERMIT NUMBER
SPOKANE'COUNTY — DEPARTMENT OF BUILDING &SAFETY' g44 — 15 -0
NORTH 811 JEFFERSON/SPOKANE,WASHINGTON 99260/(509)456-3675
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
STREET ADDRESS PARCEL NO. �
1. /�3/.1� . �, .4v e� v �'f,A4 -) C) Ir
LOT BLOCK SUBDIVISION LEGAL DESCRIPTION:
2. C., 7:--z�.f- g.. - SI,Q►-7z ,471-. 7 -/f 7
OWNER PHONE PHONE
3. 1 ' '.C' v,4c'shc. hC- , 92, -095z -Ti- c4- 6 - ch -4 4..'1- 74-ii7
MAILING ADDRESS / f ZIP �+ Actual Set Backs in Feet to:
74 0. 1p!J'X / .c>,PjL. �po i Z'm c-(1 H '7 Z f North £ 'South.3 c,j East 2,0 I West . 7i
CONTRACTOR LICENSE EXPIRES PHONE Size of Parcel Zor►�CCpsificati n - Residential
:S.
P q it X i. C, -. 1"7 Commercia
4. ADDRESS ZIP Type ns. •• y Sprinklered
y ❑Yes *No ❑Req'd.
DESIGNER PHONE N Const.Valuation /Remodeled Valuation Total Bldg.Floor Area
5. 474--
ADDRESS ZIP Main Floor Upper Floors Garage/Storage Greenhouse
9 .'7L ,. - 9 v
CHANGE OF USE FROM TO Cover Deck Un .Deck Fin. ent UnfBasement
6. --- - lie k- _ 9 ' G G ,,
No.Barns No.Floors No.Fin.Rooms No.Dwellings * ,
TYPE ' 'NEW ❑ ALT. ❑ AD'N. ❑ RPL. ❑ MVE. _
j /
7• OF _. ❑ OTHER ' —> r
WORK ALBLD. ❑ PLMB. ❑ MECH. ❑ M.H. ❑ POOL Certifi.of Exempt. Required Yes NoRk Number
or Variance Received Yes❑ No❑ —
DESCRIBE/WORK /J Shorelines/Flood Hazard Plans Required❑ /I
8. S, /19/ Fosni,1 ,cv_S' l-0 I( C. — �7�^,3,�yC.• Yes❑ NotAppiic.X Received LI 7 r
VALUATION SOURCE GAS ELECTRIC WATER SEWAGE Ownership FEES COLLECTED
9 PUBLTE 0 SEPTICS Public❑Private
UTILITIES Hca r4, PRIVATES❑ SEWS ❑__
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 Building
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 Plumbing
SIGNATURE OF -� Z .
/ APPLICATION e'
OWNER OR AGENT e ‘ . ._ „
‘ .'._ / DATE teas-ch F', fgg P('-, Mech.
SPECIAL APPROVALS SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PRELIM. FINAL DATE�{ P Plan Check
Env.Health / /. � "
/ SEPA
Planning Modular/
MFG.Home
Fire O.
Prevent. p
Engineer V, �i C Other(Specify) W
Utilities .7,^ LL
TOTAL $ I
SEPA
PERMIT IS NONTRANSFERABLE WHEN MACHINE VALIDATED IN THIS SPACE,
Plans �i ,�� THIS BECOMES A PERMIT.
Exam. '7?( , / rir PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
Building ` I IN 180 DAYS
Tech. ' I DATES1llt 8 -8 4 PERMIT d • AL
�1 r� 5. 0 ' *291. 00 I
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