1984, 02-29 Permit: 84A-1700 AdditionPLAN NUMBER
APPL.ICA.STION/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. t2 3 e 7'r`H
LOT BLOCK
2. 10
OWNER
3. D UINAte- L, REP
SUBDIVISION
MAILING ADDRESS
/2?0.3 • 7
CONTRACTOR
4.
PHONE
P172-6
z't 1
ADDRESS
LICENSE EXPIRES
DESIGNER
5.
ADDRESS
CHANGE OF USE FROM
•
PHONE
ZIP
PHONE
ZIP
TO
TYPE $.NEW 0 ALT. fg.AD'N. 0 RPL. 0 MVE.
7. OF O OTHER
WORK ❑ BLD. 0 PLMB. 0 MECH. 0 M.H. 0 POOL
PARCEL NO. q Z - /95(0.
LEGAL DESCRIPTION:
Actual Set Backs in Feet to:
North 40 f 'South6161—. East
Size of Parcel
30431° X.03
YPe OocuAancy
New Const. Valuation
Cover Deck
No. Baths
Certifi. of Exempt.
or Variance
West
Zone Classification
Residential
Qormierci ❑
Spr nklered
❑Yee ❑No Req 'd.
Remode ed Valuation
Uncv. Deck
No. Floors
Total Bldg. Floor Area
Greenhouse
Fin. Basement
No. Fin. Rooms
Required Yes No0
Received Yes No❑
DESCRIBE WORK IES p 4.jcG' ABY C i -65. fA1 wrq rn
VALUATION
9.
SOURCE
UTILITIES
GAS
ELECTRIC
Shorelines/Flood Hazard
YesD Not ApplIc. ❑
WATER
PUBLIC
PRIVATE
SEWAG
SEPTIC
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 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 ����
OWNER OR AGENT /-Gv`
O,c
APPLICATION
DATE2 f �, tJ�
SPECIAL APPROVALS
PRELIM. FINAL DATE
Env. Health
Planning
SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
PERMIT IS NONTRANSFERABLE
PERMIT 1S NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
Unfin. Basement
No. Dwellings
Plans Requ'red ❑
Received 0
FEES COLLECTED
t?
Building 06,(19--
Plumbing
Mech.
Plan Check
SEPA
Modular/
MFG. Home
Other (Specify)
TOTAL $
PERMIT NUMBER
944 — 1100
02* *18600
*186006
A *000
169.6g
02-29-84
2 6479:
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATEYSUEr 9 - 8 4
PERMIT'N6.o' O Z *1 R 6, O 0 4o?TAL
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