1984, 02-28 Permit: 84A-1639 ResidencePLAN NUMBER - . APPLICATION/PERNIFT ' ,
SPOKANE COUNTY — DEPARTMeN*T OF BUILDING & SAFETY
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
ADDRESS
ZIP
APPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 3 COPIES
FloorsGarage/Storage
STREET ADDRESS
Greenhouse
PARCEL NO.
�.
.'�ZU
CHANGE OF USE FROM
TO
Cover Deck
LOT
I BLOCK
SUBDIVISION
Unfin. Basement
LEGAL DESCRIPTION:
No. Baths No.
Floors
No. Fin. Rooms
OWNER
PHONE
PHONE
3.
l
7 ❑OTHER
MAILING ADDRESS
ZIP
Certifi. of Exempt.
Actual Set Backs in Feet to:
Yes❑ NdV
\C
1Ae_t ~
Yes❑ No❑
North _6C_�)' South East \�' West
15�
Shorelines/ Flood Hazard
CONTRACTOR
Required V/
LICENSE EXPIRES
PHONE
Size of Parcel
Zone Classification
Residential
4.
MC
PUBLICR❑
SSEAGE E TIC
Ownership
X i'_;01'7--1Commercial
❑
ADDRESS
PRIVATE
SEWER
ZIP
Ty2!LWst.
Occupancy
Spri nklered
provisions included on
M
reverse side, and know the same to be true and correct. All provisions of laws and ordinances governing this type of
4CCI 'to
N
-
❑Yes ❑No
❑Req'd.
DESIGNER
of construction. SEE REVERSE SIDE FOR REQUIRED INSPECTIONS
Plumbing
PHONE
SIGNATURE OF/ APPLICATI
New Const. Valuation
Remodeled Valuation
Total Bldg. Floor Area
5.
ADDRESS
ZIP
Main Floor Upper
FloorsGarage/Storage
Greenhouse
CHANGE OF USE FROM
TO
Cover Deck
Uncv. Deck
Fin. Basement
Unfin. Basement
No. Baths No.
Floors
No. Fin. Rooms
No. Dwellings
TYPE/NEW El ALT. ElAD'N. El RPL. E-1MVE.
Z
l
7 ❑OTHER
H
WORK BLElElD. PLMB. ❑ MECH. ❑ M.H. POOL
Certifi. of Exempt.
Required
Yes❑ NdV
Number
or Variance
Received
Yes❑ No❑
DESCRIBE WORK
8•
Shorelines/ Flood Hazard
Plans
Required V/
!Zwe�=5�m_t-k_�
Yes❑ Not Applic. ❑
Received t7J
VALUATION
9•
I SOOUFCE
GAS
ELECTRIC
PUBLICR❑
SSEAGE E TIC
Ownership
FEES COLLECTED
UTILITIES
PRIVATE
SEWER
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
4CCI 'to
work will be complied with whether specified herein or not. The granting of a permit does not presume to give au-
Building
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
OWNER OR AGENTY f • DATE `C
Mach.
SPECIAL APPROVALS
Env. Health I l,r F I�
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PERMIT IS NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
Plan Check
SEPA
Modular/
MFG. Home
Other (Specify)
PERM � UMB /R
TOTAL $ k' 1
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATE(ISSUi62 8— 8 n PERMIT1NO. 3 9 6 * 4 0 9, O 0 MWAL
CL
O
V
W
i
LL
w.,
10�.k- 3
c-,fvl r'w
*Apr f s
12001 - 25th Ave.
y
9%
..,se -57
lull