1984, 04-24 Permit: 84A-3721 Residence PLAN NUMBER APPLICATION/PERMIT PERMIT NUMBER
SPOKANE COUNTY — ilEPARTMENT OF BUILDING & SAFETY- , , glA - -j/ 2
NORTH 811 JEFFERSON /SPOKANE,WASHINGTON 99260/(509)456-3675
APPLICANT: COMPLETE NUMBERED SPACES— PRESS HARD TO MAKE 3 COPIES
STREET ADDRESS PARCEL NO.
1. E- • kaCo1CD 14:rA "Z.'2....S 4-3-izSi
LOT BLOCK SUBDIVISION LEGAL DESCRIPTION:
2. t2 'Z. _j l?cacti`S A06-)
OWNER PHONE PHONE
3. --D$.V e Sc_c k-N X2.1-lydiel
MAILING ADDRESS ZIP Actual Set Backs in Feet to:
North 4(t (South [East I West 1SI
CONTRACTOR , LICENSE EXPIRES PHONE Size of Parcel Zone Classification Residential El'
G3ZCN'b' f -tt Si.L`�' C k i t . Commercial❑ (- - z
4. ADDRESS ZZIIPi' ittcnst. Occupancy Sprinklered
a� • 1 15 ^1Z i V .C.4_A L-iv. eM '� N ' f'YI-f ❑Yes 0 N ❑Req'd. * 1 0 0 c=
DESIGNER PHONE ewConst.Valuation Remodeled Valuation Total Bldg.Floor Area S 9 i4C r'
5.
I-5',
ADDRESS ZIP Main Floor' Upper Floors Gara a/Storage Greenhouse / v
1. - 1 3 576- —
CHANGE OF USE FROM TO Cover Deck Uncv.Deck Fin.Basement Unfin.Basement '
[i [ _ < [_
6. Z.e?,.?2 l l oe, ' (+ 7 9,
No.Baths No.Floors No.Fin.Rooms No.Dwellings
TYPE ® NEW ❑ ALT. ❑ AD'N. ❑ RPL. ❑ MVE. "?j `-" l b l
7. OF ❑ OTHER /
WORK GYf3LD. ❑ PLMB. ❑ MECH. ❑ M.H. ❑ POOL Certifi.of Exempt. Required Yes No's( Number
or Variance Received Yes❑ No❑
DESCRIBE WORK Shorelines/Flood Hazard Plans Required Pl
8•Qf .vc Yes Not Applic.❑ Received Ip
VALUATION SOURCE GAS ELECTRIC WATER_ / SEWAGE" Ownership FEES COLLECTED
9 OFit/
UTILITIES PUBLIC�r SEPTIC
PRIVATE❑ SEWER❑S Public❑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 Building 4
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 Plumbing
SIGNATURE OF APPLICATI(N 214i /`��/
OWNER OR AGENT ---Q'� -y+���-� DATE , / Mech.
SPECIAL APPROVALS SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PRELIM. FINAL DATE Plan Check
Env.Health `.
)f. � /�• SEPA
Planning
Modular/
MFG.Home
Fire t,,0,-4......- d
Prevent. $� ^-C O
Engineer1§C ‘..10‘.' 00'4
� V
ir' / Other(Specify) t1J
Utilities •Y �zs �// I 4-33
TOTAL $
SEPA
WHEN MACHINE VALIDATED
Plans / PERMIT IS NONTRANSFERABLE THIS BECOMES A PERMIT. IN THIS SPACE,
Exam. �' ki PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED p 7
Tech mg IR! IN 180 DAYS (1 Q DATEYS3UE� 4 U 4 PERMIT-741Z 2, 1 z * 4 5 3,0 0 QOITAL