1984, 01-17 Permit: 84A-469 Residence •
PLAN NUMBER APPLI •AT ION/PERMITPERMIT NUMBER
SPOKANE COUNTY = DEPARTMENT OF BUILDING &SAFETY B4 A - 4(061
NORTH 811 JEFFERSON /SPOKANE,WASHINGTON 99260/(509)456-3675
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
STREET ADDRESS1. PARCEL NO.
LOT BLOCK SUBDIVISION DESCRIPTION:
2. 7 �V hLI.= ArPr.
JER I
ONE PHONE
3 k 2.5-2_,
MAILING ADDRESS
Actual Set Backs in Feet to:
v - F0I ��
L�L North South East i West
CONTRACTOR LICENSE EXPIRES PHONE Size of Parcel + Zone Clas i icat'on
Residential
4. "I ' ‹ _ � I r Z,� .4. y111 • Commercial❑
•
ADDRESS ZIP Type\poRT. Occupa y Sprinklered
f���I ❑Yes ❑No ❑Req'd.
DESIGNER PHONE NewConst.Valuation Remodeled Valuation Total Bldg.Floor Area
5. ADDRESS F7"1 �!�C -
ZIP Mai oor Upper Floors Garage/ forage Greenhouse
CHANGE OF USE FROM TO Cover Clack Uncv.Deck Fin.Basement Unf in.Basement
6.
No.BathsthNo.Floors No.Fin.Rooms No.D1Ilings
TYPE i EW ❑ ALT. El AD'N. ❑ RPL. ❑ MVE. I
7. OF ❑ OTHER
WORK BLD. ❑ PLMB. ❑ MECH. ❑ M.H. ❑ POOL Certifi.of Exempt. Required Yes No Number
or Variance Received Yes No
8. DESCRIBE WORK Shorelines/Flood Hazard Plans R uired v
C vJ hp a E/ Yes❑ Not Applic.D Received
VALUATION SOURCE GAS ELECT/ RIC PUBLICg] SEPTIIC Ownership FEES COLLECTED
9. UTILITIES PRIVATE❑ SEWER❑ Public 0 Private Or
I hereby certify tnat 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 R;VE• .E SIDE FOR REQUIR D INSPECTIONS Plumbing
SIGNATURE OF 11,
) APDL CATION _ _ .S7 /
OWNER OR AGENT .1 A 1/ I.
\ c, / Mech.
SPECIAL APPROV•LS SPECIAL CONDITIONS:(SEE REVERSE SIDE FOR NOTICE)
PRELIM. FIN' DATE Plan Check
Env.Health
0
1)02
SEPA
Planning
Modular/
Fire MFG.Home
Prevent. O.
O
Engineer
414/11-404 Other(Specify) LI
Utilities —J
J_
3Z C,3
TOTAL $
SEPA
Plans 1%% PERMIT IS NONTRANSFERABLE WHEN MACHINE VALIDATED IN THIS SPACE,
Exam �� /fo cJ THIS BECOMES A PERMIT.
Building /`/ PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
Tech. IN 180 DAYS n 14.4 n
DATH11S6UEa 7 —8 4 PERMIT N®.6. 9 5 * 3 2 60 0 02dTAL
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