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1984, 05-23 Permit: 84A-3964 ResidencePLAN NUMBER APPLIC,,4TION /PERMIT a 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 STREET ADDRESS PARCEL NO. 1. `t. kC�ll-7 i rr� - aZCSc�I LOT BLOCK SUBDIVISION 11 Fr -,AI r1FCrRIPTI0N- Actual Set Backs in Feet to: TO North South East West Size of Parcel OWNER , Zone Classification PHONE � PHONE '5r rz k..D ?-> -IG . Occupancy Sprinklered e�?4 -Cd' 3. M LING ADDRESS Const. Val tion Remodeled Valuation ZIP � �. MainFl r, CONTRACTOR Gara /Storage LICENSE EXPIRES PHONE L SAv� or Variance Received Yes❑ No❑ MFG. Home 4. Shorelines/Flood Hazard Plans Required 8. t rV(�C7 Yes❑ NotApplic. ❑ Received ADDRESS SOURCE GAS ZIP WATER DESIGNER Ownership / PHONE 9 OF UTILITIES PUBLIC PRIVATE ❑ 5. public ❑ Private'H I hereby certify that I have read and examined this application and have read the "NOTICE" provisions included on ADDRESS reverse side, and know the same to be true and correct. All provisions of laws and ordinances governing this type of�,7 ZIP Actual Set Backs in Feet to: TO North South East West Size of Parcel 6. Zone Classification Residentia � - '5r rz Commercial C L Ty Const. Occupancy Sprinklered No. Dwellings r_.� n4-� Dyes ❑No ❑Req'd. Const. Val tion Remodeled Valuation Total8ldg. Floor Area � MainFl r, Upper Floors � Gara /Storage Greenhouse CHANGE OF USE FROM TO Cover Deck Uncv. Deck Fin. Basement � Unfin. B ement 99 6. � - / No. Baths No. Floors No. Finooms No. Dwellings TYPE L NEW El ALT. ElAD' N. E] RPL. 1:1MVE. 2 Z `� r) 7. OF / ❑ OTHER WORK © BLD. ❑ PLMB. ❑ MECH. ❑ M.H. ❑ POOL Certifi. of Exempt. Required Yes No2f L or Variance Received Yes❑ No❑ MFG. Home DE CRIBE WORK Shorelines/Flood Hazard Plans Required 8. t rV(�C7 Yes❑ NotApplic. ❑ Received VALUATION SOURCE GAS ELECTRIC WATER SEWAGE Ee Ownership / FEES COLLECTED 9 OF UTILITIES PUBLIC PRIVATE ❑ SEPTIC SEWER ❑ public ❑ Private'H 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�,7 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 WHEN MACHINE VALIDATED IN THIS SPACE, of construction. SEE REVERS SIDE FOR REQUIRED INSPECTIONS Plumbing SIGNATURE OF APPLICATION �0 MArntco nR Ar-'=KITy' _... , �� 1 DATE Mech. PERMIT NUMBER �5q SPECIAL APPROVALS SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE) Plan Check PRELIM FIN DATE, Env. Health SEPA Modular/ Planning MFG. Home y tL Fire Prevent. O f�=AE- Other (Specify) W J LL Engineer Utilities ' TOTAL $. SEPA WHEN MACHINE VALIDATED IN THIS SPACE, Plans PERMIT IS NONTRANSFERABLE THIS BECOMES A PERMIT. Exam. PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED Building Tech. IN 180 DAYS DATA UE PERMIT TOTAL � q3-84 3"��6,42 * 3 ° 11.u0°°- BUILDING PERMIT APPLICATION WORKSHEET PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND (Please return this original and your building plans to the Department of Building and Safety) 1 Owner's Name (last) (first) (m) Department Use Ras. Comm ed a h C 2 Project Address (not Mailing Address) or Road Name Space Zip /_ .j 3 City/Community State Subdivision/ Plat Name !sf- e k c 5�� ;�i� 4 Assessor Parcel No. Lot • Block / * * * DEPARTMENT USE ONLY * # / / Zone Act. 0 Zone Project No. c elI# No. of Buildings Sq. Ft. Acre Depth Frontage l 1 Z, F; r FCode Back -Front (L)S-1 J(R)S-2 Rear Census Tract Module No. Initials L AZT �7 Zd1 hitect Firm Name Street Address City State Phone Contact Person Phone If different than above Contractor Firm Name ! Street A54ress ^p �Q p Zip City State Phone Z/ cthe / Contact Per. License No. Phone if different than above 8 Owner/Agent (if different than k1 above) Business Address 9 Zip City State Phone 12 Review Required Plan Check (YIN) Other (Y N) SEPA Exempt (Y/ N) Date 15 Type Work Bldg ❑ MH New 11 Replace El Other ❑ Fire ❑ Demo ❑ Add/Alter ❑ Move 14 DescribeWork 10 Applicant/NJame Str Address /i, f �` SSb C a 2= - p ; d 11 Zip City State Phone (�(1) C — r Lender pp Street Address +Q (�1�1 Y���C° ��d/Ceti Af o r gel 41 11 ( Zip City State Phone Contact Person Phone if different than above Additional Information DEPARTMENT APPROVALS Application Type This is not a Permit (Standard unless (Indicated approvals required in either "release" or "release with conditions" otherwise indicated) space prior to permit issuance.) ❑ Fast Track I-- ❑ Earl Start y Release Release I w/cond 1 Hold 2 Environmental Health ❑ Commercial; ❑ Residential W. 1101 College ❑ New Construction; ❑ Bldg alteration/addition Room 200 ❑ Additional structure; APPLICATION #� Conditions/ Comments: Gni/ 6�11C.•�. ❑ Planning/Zoning: ❑ Commercial; ❑ Cert. of Exemption; ❑ Frontage; N. 721 Jefferson ❑ Setbacks; ❑ lot w/d; ❑ lot size; ❑ use/zone; ❑ CU, variance, zone change; shoreline; ❑ fence; ❑ Other Conditions/ Comments: Engineers: N. 811 Jefferson ❑ Commercial; ❑ drainage - R dential; ElFlood Plain; new access /approach; ❑ fence: ❑ Utilities: N. 811 Jefferson Conditions/ Comments: ❑ I I Other: Plan Exam Fire Prev. Conditions/ Comments: Project Representative Agencies Performing Special Inspection: 1. 2. 3. i indicate above or attach conditions relative to final as built approval 2 Indicate above or attach reasons for hold Telephone