1984, 04-16 Permit: 84A-3392 ResidencePLAN NUMBER APPLICAT SON/PERMIT
SPOKANE COUNTY — ■DEMRTMENT OF BUILDING & SAFETY
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
6.
l;r"A" ut: Ur ust FHOM TO
AP
Q SPACES_PRESS
HAR E3COPIE
STREET ADDRESS
010 4-s
CEL NO.
7•
TYPE ❑ALT. ❑ AD'N. ❑RPL.
❑ MVE.
No. Baths No. Floors
1 2
No. FI Rooms No. Dwellinf
i
2C�h+�JgRl��i+Tt-�
tslt�
OF ZD.
IVIsIONAL
DESCRIPTION:
WORK BLD. ❑ PLMB. ❑ MECH. ❑ M. H.
❑ POOL
Certifi.ofExempt.
Required
OWNER
PHONE
4PHONESIzeof
MAILING ADDRESS
or Variance
Received
l Set Backs in Feet to:
8.
D SCRIBE WORK
iif
South East WestCONTRACTOR
Plans Required
4
C -c_
)frN C 115
LICENSE EXPIRES
Yes❑ Not Applic. ❑
Parcel
ZoneClassif!cationResidential
VALUATION
4.
y�
ELECTRIC
I WATE
SEWAG
(0 K
Commercial ❑
g
ADDRESS
of
UTILITIES
ZIP
J�, °nst.
Occupancy
Sprinklered
5-7�4 Mor
FEES COLLECTED
Gam '
Dyes ❑No ❑Req'd.
DESIGNER
PHONE
nst. Valuation
Remodeled Valuation
Total Bldg. Floor Area
5.
VOG
ADDRESS
ZIP
Main Floor
Upper Floors
Garageltorage
Greenha�e
ra
6.
l;r"A" ut: Ur ust FHOM TO
Cover Deck Uncv. Deck
Fin. Basement Unfiinn. Basi
7•
TYPE ❑ALT. ❑ AD'N. ❑RPL.
❑ MVE.
No. Baths No. Floors
1 2
No. FI Rooms No. Dwellinf
i
OF ZD.
❑ OTHER
WORK BLD. ❑ PLMB. ❑ MECH. ❑ M. H.
❑ POOL
Certifi.ofExempt.
Required
Yes❑ No
Number
or Variance
Received
Yes❑ No
8.
D SCRIBE WORK
iif
Shorelines/Flood Hazard
Plans Required
C -c_
)frN C 115
Yes❑ Not Applic. ❑
Received B
VALUATION
SOURCE
GAS
ELECTRIC
I WATE
SEWAG
Ownership
g
of
UTILITIES
PUBLIC
SEPTIC
FEES COLLECTED
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 �
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 Cance isions of any other state or local law regulating construction or the performance
of construction. SEE R ERSE SID OUIRED INSPECTIONS Plumbing
SIGNATURE OF APPLICATION �,�/
AGENT �---- DATE' j� -1S ( Mach.
SPECIAL APPROVALS SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
r PRELIM. RNAL DATE I I Plan Check
Env. Health
Planning
Fire
Prevent
t
Engineer
Utilities
SEPA
Plans Exam. PERMIT IS NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
Building ^�
Tech. IN 180 DAYS
SEPA
Modular/
MFG.Home
Other (Specify)
PERMIT NUMBER
19-4A - 3f ?,
TOTAL $'J'
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT. n
DATE�SS�EDPERMIT "N J. 9. 5* 4 5 4 0 0 #bIFAL
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