1984, 04-30 Permit: 84A-3879 DuplexPLAN NUMBER APPLICATION/PERMIT
SK,OKANE COUNTY - DEPARTMENT OF BUILDING & SAFETY
NORTH 611 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
CHANGE OF USE FROM
6.
TO
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
Uncv. Deck
Fin. Basement
STREETADDRESS
PARCEL NO.
z7
jLOT "442CY
2.17h 7
SUBDIVIS �OrN �jr�
1:`o ro�
� 99
"f0WrQ5''rr,—
LEGAL DESCRIPTION'
No. Baths No.
WNER ��
3. OAA
Pt
PHONE
PHONE
'7 /yQ
C.✓CA
7• OF ❑ OTHER
WORK V BLD. ❑ PLMB. ❑ MECH. ❑ M.H. ❑ POOL
MAILING ADDRESS
7- �
ZIP
!� (�„
Actual Set Backs in Feet to:
1 I
f
Number
or Variance
Received Yes No❑
North .541 South �� East � West
O
4.
CONTRACTOR _
Yes Not Applic. ❑
LICENSE EXPIRES
PHONE
Size of Parcel
Q I O� f
ZoneClassificetion
Comp meercatt 0
WATER
ADDRESS
Ownership
ZIP
Ty st
nc
Sprinklered
PUBLIC ❑
I PRIVATE ❑
SEPTIC.
SEWER ❑
Public ❑ Private ❑
FEES COLLECTED
1 hereby certify that I have read and examined this application and have read the "NOTICE" provisions included on
❑Yes ❑No
❑Req'd.
work will be complied with whether specified herein or not. The granting of a permit does not resume to
9 9 P P give au-
DESIGNER
thority to violate or cancel the provi ions of any other state or local law regulating construction or the performance
PHONE
NewlConst. Valuation
CD
Remodeled Valuation
Total Bldg. Floor Area
5.
Mach.
10
ADDRESS
ZIP
Upper Floors
Garag St Me glee
Greenhouse
CHANGE OF USE FROM
6.
TO
Cover Deck
Uncv. Deck
Fin. Basement
mei
z7
3 �.
TYPE. MVE.
.NEW El ALT ❑ ADN. ❑RPL.
No. Baths No.
Floors
No. Fin. Rooms
No. Dwellings
7• OF ❑ OTHER
WORK V BLD. ❑ PLMB. ❑ MECH. ❑ M.H. ❑ POOL
Certifi.ofExempt.
Required Yes❑ No❑
Number
or Variance
Received Yes No❑
8 DESCRIBE WORK
Shorelines/ Flood Hazard
Plans Required ❑
Yes Not Applic. ❑
Received ❑
VALUATION
SOURCE
of
GAS
ELECTRIC
WATER
SEWAGE
Ownership
g
UTILITfES
PUBLIC ❑
I PRIVATE ❑
SEPTIC.
SEWER ❑
Public ❑ Private ❑
FEES COLLECTED
1 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
p�-
J 5
work will be complied with whether specified herein or not. The granting of a permit does not resume to
9 9 P P give au-
Building
thority to violate or cancel the provi ions of any other state or local law regulating construction or the performance
of construction. SEE REV E SID FO EO IR D INSPECTIONS
Plumbing
SIGNATURE OF CATION
OWNER OR GENT DATE
Mach.
SPECIAL APPROVALS
PRELIM. FINAL D,
Env. Health , ^ V
Planning
Utilities
✓ Plans
Exam.
Building
t / 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)
TOTAL $
0
WPR T NUMBER
46
�l
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATIASSUED 0 -1 PERMI48. r. Q z* 5 1 " '0 . JTOPFAL
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BOX 14835. T..T.WA
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BOX 14835, OPPORTUNITY, WA
89214 NOW
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