1984, 03-08 Permit: 84A-1949 ResidencePLAN NUMBER
APPLICATION/PERMIT
SPOKANE COUNTY - DEfMPTMENT OF BUILDING & SAFETY
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
STREET ADDRESS
1. ,.•i �� ! /7
suf-� ^ `
gp{ clt_.`� 7 A c.1Zr>7 3 /-t cJa J'; a e
PHONE
LOT BLOCK
2.12 j
OWNER
3.\XtS ,pis cam.
MAILING ADDRESS
/(). rA //6P>L
CONTRACTOR
4. Sim
ADDRESS
1LYC
PHONE
%z C y}
ZIP
-q7
PARCEL NO. r*i
1
LEGAL DESCRIPTION:y)
Z.) / 12 , C/ /6 C,e /
Sci ct. a c.( <-14,-,s i"'j Ct di h 0 11
LICENSE EXPIRES
PHONE
Actual Set Backs in Feet to:
North /7/,Y,�/ jSouth �1�ry I East S / I West 3 Cy
Residential
Commercial
Size of Parcel
/c'? X -A.— T YS—
Zone
Zone Classification
rkNA
Type t. Qccupanf y Sprinklered
y :�{� ( ❑Yes *Jo Req 'd.
New Const. Valuation Remode ed Valuation Total Bldg. Floor Area
ZIP
DESIGNER
5.
ADDRESS
6.
PHONE
CHANGE OF USE FROM
TO
ZIP
Main Floor
Cover Deck
Uncv. Deck
Garage /,Storage
Fin. Basement
Greene
Unfin. Basement
TYPE g NEW ❑ ALT. ❑ AD' N. ❑ RPL. ❑ MVE.
7. OF ❑ OTHER
WORK tBLD. ❑ PLMB. ❑ MECH. ❑ M.H. ❑ POOL
No. Baths
/ s
No. Floors
No. Fin. Rooms
7
CertifI. of Exempt.
or Variance
Required
Received
Yes ❑ Nc;)4,
Yes Noel
No. Dwellings
Number
DESCRIBE WORK
8. sOrCIC-0
Shorelines/Flood Hazard
Yes ❑ Not Applic. K
Plans Required ❑
Received X
VALUATION SOURCE GAS / ELECTRIC PUWATEBj
BLIC,
9 UTILITIES eY PRIVATE ❑
SEWA
SEPTIC
SEWER ❑
Ownership
Public ❑ PrivateK
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
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
SIGNATURE OF
OWNER OR AGENT
SPECIAL APPROVALS
PRELIM. FINAL DATE
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
4die*
�+l
APPLICATI /
,� /c _ ✓ DATE _. / MISL-
SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PERMIT IS NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
FEES COLLECTED
Building
Plumbing
Mech.
Plan Check
SEPA
Modular/
MFG. Home
Other (Specify)
TOTAL $
PERMIT NUMBER(
04a— j410
ru r PAPV
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATE EDU 0 4
/ 9
PERMIT2J6.'t2 *342,00 VI' 4L