1989, 05-31 Permit App: 89001519 Residence Addition SPOKANE COUNTY DEPARTMENT OF BUILDING AND SAFETY
W. 1303 BROADWAY AVENUE
SPOKANE, WASHINGTON 99260
(509) 456-3675
I certify that I have examined this permit and state that the information contained in it and submitted by me or my agent to compile said permit is true and correct.In
addition,I have read and understand the INSPECTION REQUIREMENTS/NOTICE provisions included herein and agree to comply with same.All provisions of laws
and ordinances governing this type of work will be complied with whether specified herein or not.I understand that the issuance of this permit and any subsequent
inspection approvals or Certificates of Occupancy shall not be construed to give authority to violate or cancel the provisions of any state or local law regulating
construction,or as a warranty of conformance with the provisions of any state or local laws regulating construction.
SIGNATURE OF APPLICATION
OWNER OR AGENT DATE
PROJECT MB.. 89001519 i) E= 0}? _ ' " 9 PAGE= •.
APPLICATION
a}:*7:•? [3i a}:3t*7i 3'.**3>)i•-i *3i i it?E k)E*It }::'t*ii•)i•}i M x APPLICATION ***•3!:'N if h'**) }i:a!?:[t)t:}t f}:.^•:•' * *:c;{.*.* *.N.
SITE f I I:::T-: 1 -1522 E:: 12TH AVE F`;=-!,-1 ::Es_ :-:: 21544-2704
ADDRESS= S \, d: WA 99206
PERMIT USE= RESIDENCE ADDITION F ORSP t ROOM
F*I ;. .n..... 003653 PLAT NAME= ;. E ADD
v: OF LDrzs= :u: DWELLINGS= I
SPENCER, JAN PHONE=
STREET= 11522 1. 12TH AVE
ADDRESS= SPOKANE WA 99206
CONTACT NAME= LARRY FLEURY URY I::'HONE NUMBER= 509 928 5360
BUILDING SETBACKS : FRONT= .If`! LEFT:::: ETES RIGHT= NA REAR:::: .l'..
*****************K************ I:E'v I:E:.EW INFORMATION *•h.-*7}:*- :.-*-K** }:*:s:*-,}:;e;}:*•i}:'}:-'.::*}:: }:-F':
DATE
DEPARTMENT N - M• REVIEW ri \ " !
IN/OUT INITIALS
BUILDING & SAFETY PLAN REVIEW REQUIREn 890531'J G 'i,a
BUILDING 9 SAFETY SETBACK R
ETiC _ F :IE . REQUIRED 890531
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BUILDING X SAFETY ENERGY PLAN REVIEW1IEdREQUIRED1II : 890531 G\ „
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BUILDING,PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
(Please return this original and your building plans to the Department of Building and Safety)
1 Owner's Name (last) (first) (m) Department Use Only
SP.L•r:-t. JC Fps. Comm
2 Project Address(not Mailing Address)ar Road Name Space Zip
t S f 115aa. \-.�'' 9i a0.6
3 City/Community Statett Subdivision/Plat Name tt //
Spa K& A -e `�"., e1S `1 A 121 -1/4.11 ,q of d: - ; O c,
4 Assessor Parcel No. Lot Block
e% C $ 2/7(tV� LI ( * * * DEPARTMENT USE ONLY * * *
5 Sic Code Zone Act.C# Zone Project No.
6 Dwell# No.of Buildings Sq.Ft./Acre ' Depth Frontage
7 Set Back-Front I(L)S-1 (R)S-2 I Rear Census Tract I Module No. Initials
,
* 16 Architect Firm Name Street Address *
Zip City State Phone
( )
Contact Person Phone if different than above
( )
ntractor Firm Name Street Address
1-2.,12.ziR i Co," -7L eo yF t ?5/7s-
Zip City I State Phone
9 ci zi jf I 4 ( t8 ) 6..\74 0
Contact Person 'License No. Phoneif different than above
!- : /4 / CL'7d ( )
8 Owner/Agent(if different than#1 above) Business Address
9 Zip City State Phone
( )
12 Review Required Plan Check(Y/N) Other(Y/N) SEPA Exempt(Y/N) Date
15 Type Work Bldg 0 MH ❑ New 0 Replace ❑ Other
Fire 0 Demo Add/Alter 0 Move
14 Describe Work
10 Applicant Name Street Address
11 Zip City State Phone
( )
*
*
Lender Street Address
Zip City State Phone
( )
Contact Person Phone if different than above
( )
Additional Information
At)DI Ti OIJ j
I