1984, 02-15 Permit: 84A-1292 ResidencePLAN NUMBER - - APPLICATION /PERMIT
SPOKANE COUNTY - DEPARTMENT OF BUILDING & SAFETY
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
CHANGE OF USE FROMTO
6.
APPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 3 COPIES
STREET ADDRESS
1. e, 1
Uncv. Deck
Fin. Basement
Un in. Basement
PARCEL NO.
3 4 - < 00 (po��
LOT
2
BLOCK
SUBDIVISION
MIS L.� 6
'"I
f(] J�F'
2- t, ^_',�fI
LEGAL DESCRIPTION:
OW R
P O
PHONE
3.
% OF El OTHER
M ILING A `DRESS
�A
Required Yes❑ No❑
Z
Actualt Bac in Feet to:
or Variance
Received Yes❑ No❑
DESCRIBEWORK
8'
W
North -3 0 1 South East West
CONTRACT R
�
Plans Required
f�
�LlENSE EXPIRES
HONE
SI of Parcel
� 150
Zone Cl i on
Residenti awall
4.
ELECTRIC
WATER
PUBLIC
SEWAGE
SEPTIC
Ownership
X
,
Commercial ❑
ADDRESS
ZIP
Type, �pn�t.
V
upa y
�j
Sprinklered
❑Yes
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(QQ
�l�i-
work will be complied with whether specified herein or not. The granting of a permit does not presume to give au-
❑No ❑Req'd.
DESIGNER
of construction. SEE REVERSE SIDE FOR REQUIRED INSPECTIONS
Plumbing
PHONE
New Const. Val uatIoA
Remodeled Valuation
Total Bldg. Floor Area
5.
APPROVALS
SPECIAL CONDITIONS; (SEER VERSE SIDE FOR NOTICE)
4�1 �
PRELIM. FINAL
DATE
ADDRESS
Plan Check
Env. Health
ZIP
n Floor
Upper Floors
Garage/Storage
Greenhouse
SEPA
Planning
CHANGE OF USE FROMTO
6.
'� f1
Cover Deck
Uncv. Deck
Fin. Basement
Un in. Basement
.—�
TYPE W ALT. ❑ AD'N. ❑ RPL. MVE.
ElEl.
No. Baths No.
2
Floors
I
No. Fin. Rooms
No. Dwel4lings
% OF El OTHER
WORK BLD❑ PLMB. ❑ MECH. ElM.H. ❑ POOL
Certifi. of Exempt.
Required Yes❑ No❑
Number
or Variance
Received Yes❑ No❑
DESCRIBEWORK
8'
W
Shorelines/ Flood Hazard
Plans Required
f�
1!�-
Yes❑ Not Applic. ❑
Received ❑
VALUATION
9
SOURCE
OF
AS
ELECTRIC
WATER
PUBLIC
SEWAGE
SEPTIC
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
Building(QQ
�l�i-
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 REVERSE SIDE FOR REQUIRED INSPECTIONS
Plumbing
SIGNATURE OF0 APPLICATIO
OWNER OR AGENT --" DATE' 5 a'y
Mach.
SPECIAL
APPROVALS
SPECIAL CONDITIONS; (SEER VERSE SIDE FOR NOTICE)
PRELIM. FINAL
DATE
Plan Check
Env. Health
SEPA
Planning
Modular/
MFG. Home
Fire
Prevent.
'
Other (Specify)
Engineer
!�
Z�
Utilities
TOTAL $ — 5 -
SEPA
PERMIT NUMBER
Plans�'I+6 PERMIT IS NONTRANSFERABLE WHEN MACHINE VALIDATED IN 1 HIS SPACE,
Exam. THIS BECOMES A PERMIT.
3 PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
Building j Q j' t1
Tech. �% + IN 180 DAYS DATE I�SZED 15 - 8 4 PERMIT NO2 9, 2, z * 3 8 2, u t1TIOTEAL
CL
O
V
W
J_
LL
'� f1
Plans�'I+6 PERMIT IS NONTRANSFERABLE WHEN MACHINE VALIDATED IN 1 HIS SPACE,
Exam. THIS BECOMES A PERMIT.
3 PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
Building j Q j' t1
Tech. �% + IN 180 DAYS DATE I�SZED 15 - 8 4 PERMIT NO2 9, 2, z * 3 8 2, u t1TIOTEAL
CL
O
V
W
J_
LL
Saco ld Aoki,f ► en
no. 33511.- 9ov6
Q �.as - 3.3 Rd.
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