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SPOKANE COUNTY DEPARTMENT OF BUILDING AND SAFETY
NORTH 811 JEFFERSON
SPOKANE, WASHINGTON 99260
(509) 456-3675
I( i r;it,, ih.it I h'Ivc• t;xjinurNrd this Nornud arkl stote ih<tt thc Ifllpfl11il11pf1 CoIiI<witA ui il .uxi suii+mtted by me or my agerit to compdc saut pcrmd is true and COrreCi In
n-f~~i: n I hziit~ «e;u1 ~~nd urxl~~rstaiid fhu INSP[CTION REQUIREI,AENTS'NO11(.E lNC~visions ux;lu(h~cl twrcrin and ayree to Comply with All pravisions o( Iaws aixf
ordiniuxes ~)ovt,,inink} this type ol woik will be r_c,mpIH-d with whether sp~.ih~~d hL'rein Or 1101 I wxlersi,tnd that thE: issusnCi; ol Ihis permd a!id any subseqirenl inspechon
,ipprovals ur CerUhc:ates of OccuJ)ancy shail n;it be con:.Uux:d to gi+re authotity lo viol:,te or can.:0 thEt prc;wsions ot any state or local law recitilatir-ki constructrun or as a
warraMy ot c;ontarmance wdh the provisions of any state c.>r lacr,l lavrs «qulating construct►aI
SIGNATURE OF APPLICATION
OWNER OR AGENT DA1E
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INFORMATION WORKSHEET
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* # OF BUILDINGS: # OF DWELLINGS: *
* OWi1ER: 6d1~97L1rL_y~,~f PLIoNE: - *
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* MAILING ADDRESS: *
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* CITY/STATE/ZIP: *
* CONTACT: PHONE: - - *
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* SETBACRS - FRONT: LEFT: RIGHT: REAR: *
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* PEFZtrffT USE : i(/~&)
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* BUILDING INFORMATION *
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* CONTRAC'I'OR LICENSE NO. : ,!/127'WSd 14L/ CIC~zl *
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* CONTRACT'OR : ~C/~1~"'~~ f~~'' ,~Cs~ ~ ~ • PHONE =
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* MA.TLING ADDRE.SS : /'ldo~
* ARCHITECT/ENGINEEFt: PHONE: - - * .
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* MAILING ADDRE.SS: *
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* NEW= REMQDEL: ADDITION: CHANGE OF USE: *
* DWELL iJNITS : OCCUPA,NT IAAD : BUILDING HGT : STORIES : *
* BUILDING DIMENSIONS : X ( WIDTF; X DEPTH ) SQ. FT _ * -
*REGUIRED PA►R.RING : # HANDICAP : SEWF~Z: ( Y/N AYllRANT: *
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