1984, 03-12 Permit: 84A-2097 ResidencePLAT NNUMBER APPLICATION/PERMIT
L-- SPOKAN8 COUNTY = DEPARTMENT OF BUILDING & SAFETY
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 3 COPIES
STREETADDRESS PARCEL NO.
LOT
2.
OW EER
3.
MAILING
4
DESIGNER
5. ADDRESS
SUBDIVISION LEGAL DESCRIPTION:
f1ioiwM6 2 dQ jWJ
PHONE
it
PHONE
Zone CI i itin
Residential
Commercial ❑
TypeV4
ZIP
Sprinklered
❑Yes ❑No ❑Req'd.
New ! Const. Valuation
n 7
s�
LICENSE EXPIRES
PHONE
Mai Floor
Upper Floors
Garage/ ag
ZIP
PHONE
North w. V South 3 / East O West 15
Size of Parcel
Zone CI i itin
Residential
Commercial ❑
TypeV4
Opcupancy
I
Sprinklered
❑Yes ❑No ❑Req'd.
New ! Const. Valuation
n 7
s�
Remodeled Valuation
7
Total Bldg. Floor Area
Mai Floor
Upper Floors
Garage/ ag
Greenhouse
CHANGE OF USE FROM
TO
k
Uncv. Deck
in. Basement
U}fin. Basement
No.
Floors
No. Fin. Rooms
No. Dwellings
TYPE ❑ ALT. ❑ AD' N. ❑ RPL.
❑ MVE.
OF 7
/hW
❑OTHER
BLD. ❑ PLMB. ❑ MECH. ❑ M.H.
❑ POOL
rNoBath
Exempt.
Required
Yes❑ No❑
Number
WORK
Received
Yes❑ No❑DESCRIBEWORK
`' �
relines/Flood Hazard
Plans Required
8. N
❑ Not Applic. ❑
Received
VALUATION
SOURCE
OF
AS
ELECTRIC
WATER
PUBLIC
SEWAGE
SEPTIC
p
FEES COLLECTED
9• 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
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 FO OUIR D INtnECTIONS
SIGNATURE OF ';' 2Z 117Z APPLICATION C'
OWNER OR AGENT DATE _J/ / '11�
Env. Health PRELIM. F� DATE LiC MG� INV 7�
Planning
Prevent.
Engineer t f1 i +` r
Utilities
SEPA
Plans PERMIT IS NONTRANSFERABLE
Exam. r01
�� PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
Building IN 180 DAYS
Building
Plumbing
Mech.
Plan Check
SEPA
Modular/
MFG.Home
Other (Specify)
3&z -
PERMIT NUMBER
S - zaq
TOTAL $ 3
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT. 7.7z *2' i
*E1
DATE' 9U PERMI". OTAL
Ole
ICY"
i.
J 71o"t
1�07-91
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