Sprague E 8112 Steven Baldwin Sign
?LAN NUMBEIi AppLICATIOH/PERMIT pERMIT NUMBER
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~ SPOKANE COUNTY - BUILDING COOES DEPAATMENT
NORTH 811 JEFFERSON ! SPOKANE, WASHINGTON 89280 /(609) 498-3676
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APPLICANt: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 3 COPIES
Joe ADDRESS LEGAL DESCRIPTION - SEE ATTACHED
1 P~
Lpr PARCEL NUMBBR/S
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OWNER PHONE
3 SMgvQn G. Haldain 922-7386
ADDRESS ZIP Aetual Set Backs in Feet
~ W2 Spraaue, Spokane, WA. 99206 o<<h Isouth LM ~West
CpNTRACTOR PHQNE ite o/ Parcel Zane CIec9MlCattan
4 Heath Northwest, Inc. 455•8666
ADDRESS ZIP Type Ccnst OtcuOancY Spriektered
E. 411 Spraque{ Spokane, WA. 99202 aYes MNo o aeq'a
OESIGNER PHONE Valuation Bullding Area In Sa Ft
~ 51600.00 40 sq, ft.
5 ADDRESS tIP Maln Ptoor Upper Ffoors Garage Aree Storaga
Ci1ANGE OF USE FROM TO Araa of Oackf F1niNed 'Baaement Untln Basement s Buaineea Husineae
Na Bath9 NO Storief PIO Roams No. ot Owallings NPE 0 NEW ❑ ALT ❑ AD'N ❑ RPL ❑ MVE
7 OF 9 OTHEFi CERTIFICATE !iM'd AeCd `Not Raq'd
WORK ~ 8LD ❑ PLMB ❑ MECH ❑ M.H ❑ POOL
ol EXEMPTION
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DESCRIBE WORK Enum. Olst Location (Arss) FEFSCOLLFCTEO
e Siqn Inetellation
VALUATION gpURCE dAS ELEC7RIC WATER SEWER pNmership USE COOE
9$1600 • OO UTI ~ TIES Pubilc ❑ Prlrate ❑ singte $
I hereby certify that t have read and exammed this application and have read the "NOTICE" provisions mcluded
on reverse side, and know the same to be true and correct All provisions of (aws and ordmartces goverrnng dhis guiiding
rype of work will be complied with whether specified herein or not 7he g►antmg af a permit das not prewme
to give authonty to violste or cancel the provosions of any other state or ioca) law regulating construction or the
performance of construction, SEE REVERSE SIDE FOR REOUIRED INSPECTIONS Piumbing
DATE OF APPLICATION SIGNATURE OF APPLICANT Mach'
SPECIAL AP1RpVALS SPECIAL CONOITfONS
NAME OATE Plen Check
Env Health
SEPA
9' I
Mobile Home
Fe rsnaii
co n9~ b Other ISPecityl
uU rtias TOTAL $
Plan9 E%Dmlflef . - •
WHEN MACHINE VALIDATED IN THIS SPACE,
SEPA Chetklist THIS BECOMES A PERMiT.
8ullding tethnielan PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAA FROM DATE OF ISSUANCE DATE ISSUEO PERMIT NO tOTA
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