1984, 01-17 Permit App: 84A-500 Inspectioni 0r'UF%JlA VC %.#UUN I T — LJr-rMrI 1 MCIV 1 Ur OUILLJ114U a JHrC I T
NORTH 811 JEFFERSON/ SPOKANE, WASHINGTON 992601(509)456-3675
ADDRESS
ZIP
APPLICANT: COMPLETE NUMBERED SPACES -
PRESS HARD TO MAKE 3 COPIES
Modular/
STREETADDRESS
PARCEL NO.
�.
1011-7
❑Yes ❑No ❑Req'd.
DESIGNER
LOT
BLOCK
SUBDIVISION
Total Bldg. Floor Area
LEGAL DESCRIPTION:
2.
I
OWNER
PHONE'S
PHONE
3.
Floors
`
Greenhouse
! O ?
M ILING ADDRESS
SEPA
ZIP
Actual Set Backs in Feet to:
CHANGE OF USE FROM
TO
Cover Deck
Uncv. Deck
NorthSouth East West
Unfin. Basement
CONTRACTOR
6.
LICENSE EXPIRES
PHONE
Size of Parcel
Zone Classification
Residential ❑
4
No. Baths No.
Floors
No. Fin. Rooms
No. Dwellings
DATE" PERMIT N. 0 , MOT -AL
I Commercial ❑
ADDRESS
ZIP
Type Const.
Occupancy
Modular/
Sprinklered
MFG. Home >_
CL
O
Fire
Prevent.
❑Yes ❑No ❑Req'd.
DESIGNER
PHONE
New Const. Valuation
Remodeled Valuation _T
Total Bldg. Floor Area
Engineer
5.
ADDRESS
ZIP
Main Floor Upper
Floors
Garage/Storage
Greenhouse
TOTAL $
SEPA
CHANGE OF USE FROM
TO
Cover Deck
Uncv. Deck
Fin. Basement
Unfin. Basement
6.
Exam.
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS " _
&17
Building
Tech.
No. Baths No.
Floors
No. Fin. Rooms
No. Dwellings
DATE" PERMIT N. 0 , MOT -AL
TYPE 11 NEW El ALT. ❑ AD' N. 11 RPL. El MVE.
7 OF El OTHER
_T
WORK El BLD. El PLMB. El MECH. ❑ M.H. El POOL
Certifi.ofExempt.
Required
Yes❑ No El
Number
or Variance
Received
Yes❑ No❑
8 DESCRIBE WORK �fl //v��. per/ ►� l // ✓
�t
Shorelines/ Flood Hazard
Plans Required ❑
WIm." 105t wT10Q 1.�iPiN �
Yes❑ NotApplic.❑
Received ❑
VALUATION I
SOOUFCE
GAS
ELECTRIC
PUBLICR❑
SEPT CGO
Ownership
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
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 REVERSE DE FOR REQUIRED INSPECTION
Plumbing
SIGNATURE OF\ `
lAPPLICATION
OWNER OR AGENT Gt t __-BATE '�/�_
Mech.
SPECIAL APPROVALS
SPE I L CONDITIONS: (, REVERSE SIDE FOR NOTICE)
PRELIM. FINAL DATE
Plan Check
Env. Health
SEPA
Planning
I �_ : /-T i :: V I
Modular/
MFG. Home >_
CL
O
Fire
Prevent.
p
(Specify) � r / C3
Engineer
�Other
�LJ9L J
LL
Utilities�i
TOTAL $
SEPA
PERMIT IS NONTRANSFERABLE WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
Plans
Exam.
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS " _
&17
Building
Tech.
DATE" PERMIT N. 0 , MOT -AL