1984, 02-15 Permit: 84A-1302 Remodel PLAN NUMBER APPLICATION/PERMIT PERMIT NUMBER
SPOKANE COUNTY - DEPARTMENT OF BUILDING & SAFETY 04A - 007-
NORTH 811 JEFFERSON/SPOKANE,WASHINGTON 99260/(509)456-3675
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
STREET ADDRESSPARCEL NO.
1. (0&6- e . 1 -. T--A
LOT BLOCK SUBDIVISION LEGAL DESCRIPTION:
2.
3. OMNI R( PFIQNE,,.,-0%3 PHONE
MAILING ADDRESS (U/�t` ZIP Actual Set Backs in Feet to:
.—cetl YYI -- North 'South East l West
CONTRACTOR
��1.�^�� m�( LICENSE E PIKE ,PtH�ONNE Size of Parcel Zone Classification Residential❑
4. 11 — 97 1v 1 UIt f"W '3/1(1 11' 4U 1 -0133 Commercial❑
AD RESS '7,A !1 �,(� Z (��7 Type Const. Occupancy Sprinklered
f4 • �W OP�q�I'�— x• _l (x/7 ❑Yes ❑No ❑Req'd.
DESIGNER PHONE New Const.Valuation Remodeled Valuation Total Bldg.Floor Area
5. ADDRESS ZIP Main Floor Upper Floors Garage/Storage Greenhouse
CHANGE OF USE FROM TO Cover Deck Uncv.Deck Fin.Basement Unf in.Basement
6.
No.Baths No.Floors No.Fin.Rooms No.Dwellings
TYPE $NEW ❑ ALT. ❑ AD'N. ❑ RPL. ❑ MVE.
7. OF WORK ❑ BLD. ❑ PLMB. ❑ MECH. ❑ M.H. ❑ POOL OTHER Certifi.of Exempt. Required Yes No❑ Number
or Variance Received Yes❑ No❑
DESCRIBE WORK Shorelines/Flood Hazard Plans Required❑
8. Ij� FOAM 4� T1,4.m Vea❑ Not Applic.
❑ Received 0
VALUATION/ � SOURCE GAS ELECTRIC PUBLICO SEPTIC SEWAGE Ownership FEES COLLECTED
9 2200,✓� UTILITIES PRIVATE 0 SEWER 0 Public 0 Private❑
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 47,2%
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 IDE FOR REQUIRED INSPECTIONS Plumbing
SIGNATURE OF tt APPLICATION _
OWNER OR AGENT , '-J li`� DATE ' •� /s--___Q._4...."
���` Mech•
' SPECIAL APPROVALS SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PRELIM. FINAL DATE Plan Check
Env.Health LI! - 1* 1-E01-E-1�1lami /11j
1 l � SEPA
Planning Modular/
MFG.Home >-
Fire CL
Prevent. / p
Engineer
Other(Specify) C>
W
_J
Utilities .12:f)� LL
TOTAL $
SEPA
MACHINE
Plans PERMIT IS NONTRANSFERABLE THFIS EN BECOMES A PERM TTED IN THIS SPACE,
Exam. PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
Building IN 180 DAYS
Tech. (� 15 l 5 ga. 1 /� 7 n
DATE►n
S ED PERMIT#1� O 2z * `t / O J 7°01 AL