1984, 03-05 Permit: 84A-1843 ResidencePLAN NUMBER - APPLLCAT-iN/PERMIT 1PERMIT94A
NU��,ER,E�.SPOKANE COUNTY — DEPARTMENT OF BUILDING & SAFETY' %%��//..
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
1 STREETADDRESS j 1 >) )1 3 �^ I PARCEL NO. i
LOT I BLOCK SUBDIVISION LEGAL DESCRIPTION:
OWNER r PHONE PHONE
MA LING ADDR SSS
ZI /
��
Actual Set Backs in Feet to: t I I
El i I 11.f
I. 11 +'
North '� South �� East West
CONTRACTOR
LICENSE EXPIRES
PHONE
Size Parcel t
Zone Classifi tin
j�
r
Yes❑ No❑
s
?yL�
Shorelines/ Flood Hazard
� =tI ❑
4. ADDRESS
ZIP
Type t.
Occupancy
Sprinklered
C I +vim —r
1
❑Yes ❑No ❑Req'd.
DESIGNER
PHONE
V
I ation
Remodeled Valuation
Total Bldg. Floor Area
Plumbing
SIGNATURE OFsLC APPLICATION
kewConst.
r
i
Mech.
2_
5.
ADDRESS
ZIP
Main Floord
per Floors
Garac/S or ge
Greenhouse
T
MFG.Home
Fire
CHANGE OF USE FROM TO Cover Deck Uncv. Deck Fin. Basement Ugfin. Basement
6. J
No. Baths No. Floors No. Fin. ooms No. Dwellings
TYPE YL NEW ❑ ALT. ❑ AD'N. ❑ RPL. ❑ MVE.
7. OF WORK KBLD. ❑ PLMB. ElMECH. ❑ M.H. ❑ POOL ❑OTHER
Cartif I. of Exempt.
Required
Yes) Nod:
Number
or Variance
Received
Yes❑ No❑
s
DESCRIBE WORK
8
Shorelines/ Flood Hazard
Plans Required R t7 ) ! C
•
Yes ❑ Not Applic. %.
Received IPJ
VALUATION I SOURCE GAS ELECTRIC I WATER , ISEW,
AG�EOwnership
OF PUBLIC SEPTIC. �/
FEES COLLECTED
9 public ❑Private
UTILITIES PRIVAT ❑ SEWERR ❑ yc
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 0
work will be compiled with whether specified herein or not. The granting of a permit does not presume to give au-
thority to violate or can the provisions of any other state or local law regulating construction or the performance
of construction. SEE V SE SIDE FOR REOUIRSD INSPECTIONS
Plumbing
SIGNATURE OFsLC APPLICATION
OWNER OR AGEN r+r- DATE
Mech.
SPECIAL APP ALS SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTIC )
PRELIM NAL DATE
Plan Check
i �1
Env. Health `�(� ���� (7 {y Vl I t�� �� T
SEPA
//
Planning Y1, vr)'( i0&- kt-ry
Modular/
MFG.Home
Fire
tngineer .v, p
Utilities
SEPA
Plans
Exam.
PERMIT IS NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
Other (Specify)
C 0 0
y600Y
—21 —F11
f 4 %
39m.a. . I
TOTAL $
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES pA PERMIT.
DATEIS�l1E� 8 A PERMIT N * m0.4AL
5— 4 1�43� 590.00a�
PLA N NO. 5nn
I 1 ALT ELEVATION —
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9 900 4AL. SE.PT1t. Tk"bL
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