1984, 05-03 Permit: 84A-3987 ResidencePLAN NUMBER APPLICATJON/PERMIT
SPOKANE COUNTY - DEPARTMENT OF BUILDING & SAFETY
NORTH 611 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
CHANGE OF USE FROM
TO
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
Uncv Decd
i.
STREET ADDRESS
6.
rtu
PARCEL NO.
3 X541 — i8o�
(P
LOT
I BLOCK
SUBDIVISION
No. Fin. Rooms
No. Dwellings
LEGAL DESCRIPTION:
2.
2.
®
1
a'
S
Required
Yes❑ No❑
Number
OWNER e>1A ,T
PHONE
PHONE
ONE
3O -7
3.
1,
Shorelines/ 000d plazar❑d
Plans Required El
—130-7
Received ❑
VALUATION
�IL/IfN�G�A1pDRE S
_j1_70
1
0v
ELECTRIC
ZIPQG� �7
1
Actual Set Backs in Feet to-
o: '� �( I
155
e�
10'-r
9•
UTILITIES
` `b L-
North 3O South East may' West
:7
SEWE ❑
CO TRACTOR
LICENSE EXPIRES
PHONE
Si f Pa � I 1
Zone Classifitcation
Residential
4.
MOT
thority to violate or cancel the provisions of any other state or local law regulating construction or the
�7
t
Commercial ❑
ADDRESS
,�—
�. 1S
/�,
Alt U �-
ZIP
Type ns .
Occupancy
Sprinklered
❑Yes ❑No ❑Req'd.
5.
DESIGNER
PHONE
N n t. Valuation
aJ93001,c!9'
Remodeled Valuation
Total Bldg. Floor Area
ADDRESS
ZIP
n Floor
t;
Upper F
12
GaragelStorage
V 7 2
Greenhouse
CHANGE OF USE FROM
TO
Cover Deck
Uncv Decd
Fin. Basement
Unf' . Base
6.
G.
(P
No. Baths No.
Floors
No. Fin. Rooms
No. Dwellings
TYPE KNEW ❑ ALT. ❑ AWN. ❑ RPL. ❑ MVE.
2.
®
1
7. OF WORK XBLD. ❑ PLMB. ❑ MECH. ❑ M.H. ❑ POOL ❑ OTHER
Certifi.ofExempt.
Required
Yes❑ No❑
Number
or Variance
Received
Yes❑ No❑
8. DESCRIBE WORK y� ,r-,. n N
`a
Shorelines/ 000d plazar❑d
Plans Required El
1/GAS
Received ❑
VALUATION
SOOURCE
ELECTRIC
PUBLC WATER
�E
SEPTICffi
Ownership
FEES COLLECTED
9•
UTILITIES
PRIVATE ❑
SEWE ❑
Public ❑ Private ❑
1 hereby certify that I have read and examined this application and have read the "NOTICE"
provisionsjgive
reverse side, and know the same to be true and correct. All provisions of laws and ordinances governin
00
Building
work will be complied with whether specified herein or not. The granting of a permit does not presumau-
thority to violate or cancel the provisions of any other state or local law regulating construction or the
of construction. SEE REVE E SIDE FOR REQUIRED INSPECTIONS
Plumbing
SIGNATURE OF APPLICATION
OWNER OR AGENT0 DATE
Mach.
SPECIAL APPROVALS
SP'0CI4 CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
Plan Check
PRELIM. FINAL DATE
Env. Health
1
SEPA
Planning
Modular/
MFG. Home
Engineer
Utilities
SEPA
L/ Pians
Exam.
PERMIT IS NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
Other (Specify)
PERMIT NUMBED
A - j 0'.
TOTAL $ � I
WHEN MACHINE VALIDATED IN THIS SPACE,
THISBECOMESA PERMIT.
DATALL;` D. 3 8 4 PERMI-15NO.8 7 z * 4 6 6 U 0 jo: AL
a
oc
I
SET BACKS
2
FTGS & FORMS
3 STEEL
4
PROGRESS
5
BOND BEAMS
6
ROOF DECK
cc
7
FRAMING
8
INSULATION
9
SPECIAL INSP.
10
ASSEMBLY
11
FIREPLACE
12
EXTERIOR FINISH
13
DRYWALL
14
EXT. GRADING
115
FINAL
16
GRD. PLBG.
17 WATER PIPING
18
DWV TEST
19
FIRTURES
20 SEWAGE DISP.
c
21
SEWER
22
WATER HEATER
23
PROGRESS
.24
25
WATER SERVICE
ROOF DRAINS
26
FINAL
38
VENTI LATI ON SYS.
39
PLENUM & DUCT
140 GAS TEST
i41
FURNACE
42
DAMPERS
43 INLET/OUTLET
44
COMPBUSTION AIR
>
45
COMPRESSOR
46
APPLIANCE
47
FIRE DAMPER
48
SMOKE DETECTOR
49
HOOD
50
PROGRESS
51
FINAL
52 FINAL INSP.
0
53
FIRE PREVENT.
c
54 OCCUPANCY/TEMP.
55
REQUESTED
cn
-------------
56 OCCUPANCY/FINAL
57
OCCUPANCY/OTHER
58
COMPLAINT/ZONE
>
59
60
COMPLAINT/BLDG.
COMPLAINT/OTHER
COMMENTS: