1984, 03-08 Permit: 84A-2014 ResidencePLAN NUMBER - APPL IC'_zr ION /PERMIT
SPOKANE COUNTY — 6EpARTMENT 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. r- t U 11� cc~rM -n) 2 Sal- i •-- i so,6
WORK or Variance
Received Yes❑ No❑
DESCRIBE WORK Shorelines/ Flood Hazard Plans Required
8. r� S - Oe tvC_E Yes Not Applic. ❑ Received 2/
VALUATION SOURCE GAS ELECTRIC WATCER SEWAG Ownership FEES COLLECTED
PUBLISEPTIC
9•
LOT
BLOCK
SLDIVISION
PRIVATE ❑
SEWER ElPublic
LEGAL DESCRIPTION:
2.
'
I
I d+.i�G+zG +i
4;T
thority to violate or cancel the provisions of any other state or local law regulating construction or the performance
of construction. SEE REV SE SIDE FOR REQUUIED INSPECTIONS
Plumbing
SIGNATURE OF , APPLICATION Z2_Mach.
DATE
OWNER
PHONE
PHONE
SPECIAL C NDITIONS: (SEE REVERSE SIDE FOR NOTICE)
Plan Check
3.
'
SEPA
Modular/
MFG H
Env. Health
Q
Planning
MAILING ADDRESS
ZIP
Actual Set Backs in
Feet to:
North 56+
South
East �� West
13
CONTRACTOR
LICENSE EXPIRES
PHONE
Size of Parcel
Zone Class ification
Residential IV
�Aw.s✓
1(kQ-Cc,u`.,t�Z
--1
Commercial ❑
4.
ADDRESS
ZIP
TypeConst.
Occupancy
Sprinklered
` N miaw
'tz - V A—%
Dyes ❑No
❑Req'd.
DESIGNER
PHONEConst.
Valuation
Remodeled Valuation
Total Bldg.
Floor Area
7 !�
5.
ADDRESS
ZIP
MainFloorUpper
Floors
Garage/Stor ge
Greenhouse
CHANGE OF USE FROM
TO
Cover Deck
Un v. Dock
FinBasement
Unfin. Basement
s.
+�
"'11
�
tea►
No. Baths
No. Floors
No. Fin. Rooms
No. Dwellings
TYPE W El ALT. El AD'N.
E
❑ RPL.
El MVE.
7.
OF
BLD ❑ PLMB. ❑ MECH.
❑ M.H.
❑OTHER
❑ POOL
Certifi. of Exempt.
Required Yes❑ No
Number
WORK or Variance
Received Yes❑ No❑
DESCRIBE WORK Shorelines/ Flood Hazard Plans Required
8. r� S - Oe tvC_E Yes Not Applic. ❑ Received 2/
VALUATION SOURCE GAS ELECTRIC WATCER SEWAG Ownership FEES COLLECTED
PUBLISEPTIC
9•
UTIOF LITIES
PRIVATE ❑
SEWER ElPublic
❑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 cancel the provisions of any other state or local law regulating construction or the performance
of construction. SEE REV SE SIDE FOR REQUUIED INSPECTIONS
Plumbing
SIGNATURE OF , APPLICATION Z2_Mach.
DATE
OWNER OR AGENT
SPECIAL APPROVJYS
SPECIAL C NDITIONS: (SEE REVERSE SIDE FOR NOTICE)
Plan Check
PRELIM. FINAL DATE
'
SEPA
Modular/
MFG H
Env. Health
Q
Planning
Prevent
Utilities
Plans4 2- PERMIT IS NONTRANSFERABLE
Exam. PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
Building I IN 180 DAYS
. ome
Other (Specify)
TOTAL $ 4--21j )
WHEN MACHINE VALIDATED
THIS BECOMES A PERMIT.
PERIyjIT MBER�6 1'�+
DATEti$9UEDO 8 O 4 PERMIT1i� 4z * 4 21, O Q%o AL
,Po
AUTHOcutRIZED DEALER FOR
"nn d ll 14"
tMflr"t
111'e-t�.1Y,'fNll�! ��E.'ti
>gaAL8 t06NT�YlT f lKtEB' 80288
E5iT-3rdAVE, t7SOOKME,WA'99206
JIM JORDAN
HOME: (509) 448-2618 BUS.: (509) 534-3934
14 003 E
y 1,Ev6L
( Pk *cc iseur
EAGLE MOUNTAIN TIMBER HOMES
E. 5510 - 3RD AVENUE
SPOKANE, WA 99212-0794
(509) 534-3934
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