1984, 04-09 Permit: 84A-3089 AdditionPLAN NUMBER
APPLICATION/PERMIT
SPOKANE COUNTY — DEPAiTMENT OF BUILDING & SAFETY
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
1.
2.
STREET ADDRESS
Mt
PARCEL NO.
cnezseYS
LOT
BLOCK
SUBDIVISION
-1% ry 2 C Jvs
3.
OWNER
PHONE
PHONE
LEGAL DESCRIPTION:
MAILING ADDRESS
Z. t5O: c# 4-S
ZIP
Actual Set Backs in Feet to:
North I South ' I East
West
4.
5.
CONTRACTOR
ADDRESS
Air L -
DESIGNER
LICENSE EXPIRES
PHONE
Size of Parcel ( Zone Classification
1t ) C 0
Residential
Commercial ❑
ZIP
Type Const.
Occupancy
Sprinklered
❑Yes IOW ❑Req'd.
PHONE
qfw Const. Valuation
74-20
Remodeled Valuation
Total Bldg. Floor Area
ADDRESS
ZIP
Main Floor
ZelIn
Upper Floors
Garage/Storage
Greenhouse
CHANGE OF USE FROM
6.
TO
Cover Deck
Uncv. Deck
Fin. Basement
Unfin. Basement
TYPE 0 NEW 0 ALT. MAD'N. ❑ RPL. ❑ MVE.
7. OF
WORK NALD. 0 PLMB. 0 MECH. 0 M.H. ❑ POOL
0 OTHER
No. Baths
No. Floors
No. Fin. Rooms
No. Dwellings
Certifi. of Exempt.
or Variance
DESCRIBE WORK
8. Aoo C -'Lr
VALUATION
9.
SOURCE
OF
UTILITIES
GAS
Shorelines/Flood Hazard
Yes❑ Not Applic. ❑
Required Yes❑ No®
Received Yes No
Plans Required Q
Received Y
Number
ELECTRIC
WATER
PUBLIC
PRIVATE ❑
SEWAGE
SEPTIC O/
SEWER r7
Ownership
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
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 REVS E FO UIRED INSPECTIONS
SIGNATURE OF f /APPLICATIQN I/ " 7_4 y
OWNER OR AGENT X = DATE X
SPECIAL APPROVALS SPECIAL CONDITIONS: EE REVERSE SIDE FOR NOTICE)
PRELIM. FINAL DATE
Env. Health
Planning
N/P
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
4/q
4fy
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 $ tg 2
PERMIT NUMBER
S44 -16k -tet
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATE Ii613ED G 9- 8 4 PERMIT Nbc 8. 9
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7? DA LE UJ 19-S11f
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