1984, 04-12 Permit: 84A-3262 ResidencePLAN NUMBER APPLICATION/PERMIT
SPOKANE COUNTY - DEPARTMENT OF BUILDING & SAFETY
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
DESCRIBE WORKp _ G ^ (� /��� Shorelines/Flood Hazard Plans Requ
n _� 5 ired
8. 1 I C ^ 1 '^' Yes ❑ Not Applic. ❑ Received X
VALUATION SOURCE GAS ELECTRIC WATER SEWAGE
SEWAGE Ownership FEES COLLECTED
9• UTILLIITIES RtIVATE ❑ SEWERX
Public ElPrivatev
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
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
SIGNATURE OF i CATION is
OWNER OR AGENT � —DATE
SPECIAL APPROVALS SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PRELIM. FINAL DATE
Env. Health
Planning
Engineer
S: � • � � VW',L-� (, � �eM-��.°�- y �LK�S.i� ZG1 E)
Utilities /
SEPA
Plans PERMIT IS NONTRANSFERABLE
"'' PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
Building IN 180 DAYS
Building
VC,
Plumbing
Mech.
Plan Check
SEPA
Modular/
MFG. Home
Other (Specify)
TOTAL $ '
WHEN MACHINE VALIDATED IN
THIS BECOMES A PERMIT.
PERMITNUMBER
DATE ISSYJED 12- rPERMIT fa� "' z * 3 5 �. U O TOTAL
CL
O
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W
J
LL
APPLICANT: COMPLETE NUMBERED SPACES —PRESS
HARD TO MAKE 3 COPIES
,.
STREET ADDRESS
e_ . � e)ll R° v
PARCEL NO.
�-359 1 - i7o
2.
Lo�T
f
BLOCK
'
SUBDIVISION � � �D �n
' ry\.,Y
LEGAL DESCRIPTION:
OrNER�Gi�►E��Yi
,V t r
PHONE
PHONE
q 21e.-02163
IOI
MAILING ADDRESS
ZIP
Actua Set Backs in Feet to:
•7 t
Z
North t South 3tt+ East 7I West
CONTRtACTO _ �ts�
[�1 /�►v tj,i, - W
LICENSE EXPIRES
PHONE 7 /�
'�G a
Size of cell/
Zone Classification
Residential
Commerci
4'
ADDRESS
ADD/O
�l�n�lV CaQd
ZIP Z v
Gl)
Type Cost.
Oxupa—
aD cy
SPrinklered
❑Yes ❑kl
❑Req'd.
DESIGNER
PHONE
NCons Valuation
Remodeled Valuation
Total Bldg. Floor Area
5.
ADDRESS
ZIP
M,in Floor Upper Floors
Garage/Storage
Greenhouse
?_
CHANGE OF USE FROM
TO
Cover Deck
Uncv. Peck
C
Fin. Basement
Unfin. Basement
6.
��1i.
No. Baths
1Z_f
No. Floors
No. Fin. Rooms
5
No. Dwellings
TYPE ,NEW
❑ ALT. ❑ AD'N. ❑ RPL. 71MVE.
1
7•
OF
� BLD.
❑ PLMB. ❑ MECH. ❑ M.H. ❑POOL
❑ OTHER
a ariance empt.
Required Yes❑ No
Number
WORK
Received Yes❑ No❑
DESCRIBE WORKp _ G ^ (� /��� Shorelines/Flood Hazard Plans Requ
n _� 5 ired
8. 1 I C ^ 1 '^' Yes ❑ Not Applic. ❑ Received X
VALUATION SOURCE GAS ELECTRIC WATER SEWAGE
SEWAGE Ownership FEES COLLECTED
9• UTILLIITIES RtIVATE ❑ SEWERX
Public ElPrivatev
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
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
SIGNATURE OF i CATION is
OWNER OR AGENT � —DATE
SPECIAL APPROVALS SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PRELIM. FINAL DATE
Env. Health
Planning
Engineer
S: � • � � VW',L-� (, � �eM-��.°�- y �LK�S.i� ZG1 E)
Utilities /
SEPA
Plans PERMIT IS NONTRANSFERABLE
"'' PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
Building IN 180 DAYS
Building
VC,
Plumbing
Mech.
Plan Check
SEPA
Modular/
MFG. Home
Other (Specify)
TOTAL $ '
WHEN MACHINE VALIDATED IN
THIS BECOMES A PERMIT.
PERMITNUMBER
DATE ISSYJED 12- rPERMIT fa� "' z * 3 5 �. U O TOTAL
CL
O
V
W
J
LL