1984, 03-27 Permit: 84A-2637 ResidencePLAN NUMBER
APPL ICAT MN l RM IT PERMIT NUMBER
Cover Deck
Uncv. Deck
./
SPOKANE COUNTY - DEPARTMENT OF BUILDING & SAFETY e4Ar -
Unfin. Basement
6.
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 3 COPIES
�.
STREET ADDRE �7! t/
25 i 7C
PARCEL NO. Q_
2.
LOT
I BT
s=4W
N,-�,LEGAL
DESCRIPTION:
I
O
11'
PH
PHONE
3
Yea❑ No❑
Number
or Variance
Received
Yes❑ NoC
MAILIN9 ADDRESS
V
Shorelines/ Flood Hazard
ZIP
Actual Set Backs in Feet to: / }
Yes❑ Not Applic. ❑
Received
VALUATION
SOOURCE
��
North South East v West
PUBUC-
TIC �OwnershipFEES
1::S:
CONTR C O
Cr—
LICENSE EXPIRES
ONE
Size rcel Q
Zpn�.Classifii Qq
Residential
PRIVATE ❑
SWER ❑
Public ❑Private
I hereby certify that I have read and examined this application and have read the "NOTICE"
provisions included on
{ Ejca F 7
Commercial EJ4.
Building f
ADDRESS
ZIP
Type (pn .
upan
Or
Sprinklered
SIGNATURE OF APPLICATION �
OWNER OR AGENT i�7f%�1>f'
/ 1 DATE /HCl `7 _
'///
Oyes ❑No ❑Req'd.
DESIGNER
PHONE
New cps". Valu tion
r
Remodeled Valuation
Total Bldg. Floor Area
5.
�✓u'
ADDRESS
ZIP
Mallgor
Upper Floors
Garag /e/ orage
�j
Greenhye
� Llo
CHANGE OF USE FROM
TO
Cover Deck
Uncv. Deck
Fin. Basement
Unfin. Basement
6.
- --
TYPE N ❑ ALT. ❑ AD' N. ❑ RPL. ❑ MVE.
No.8gtns No.
`moi`
Fiools
No. Fin.rms
No. Dwellings
7. El
I
11'
WORK LD. ❑ PLMB. ❑ MECH. ❑ M.H. ❑ POOL
Certifi.ofExempt.
Required
Yea❑ No❑
Number
or Variance
Received
Yes❑ NoC
DESCRTE WORK des
8•
Shorelines/ Flood Hazard
Plans Required
W
Yes❑ Not Applic. ❑
Received
VALUATION
SOOURCE
GAS
ELECTRIC
PUBUC-
TIC �OwnershipFEES
1::S:
COLLECTED9•
UTILITIES
PRIVATE ❑
SWER ❑
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 f
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
I
of construction. SEE REVERSE SIDE FOR REQUIRED INSPECTIONS
Plumbing
SIGNATURE OF APPLICATION �
OWNER OR AGENT i�7f%�1>f'
/ 1 DATE /HCl `7 _
Mach.
SPECIAL APPROVALS
PRELIM. FINAL D.
Em. Health
w0 Pi
Planning
Engineer
Y
Utilities
SEPA
Plans
Exam.
Building
Tech.
n ti
SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
ie'o . wp . PK.
PERMIT IS NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
Plan Check
SEPA
Modular/
MFG. Home
Other (Specify)
i
TOTAL $
WHEN MACHINE VALIDATED IN THIS
THIS BECOMES A PERMIT.
-8 4/z*3 8,O/0.
DATASLIT PERMIT TOTAL
9L
O
V
W
J
LL