SPRAGUE E 5414 JIM JACK SIGN ° PLAN NUMBER APPL ICAT ION / PERM iT PER""'T "u7
~ . SPOKANE COUNTY - DEPARTMENT OF BUILQING & SAFETY
~ NORTH 811 JEFFERSON ! SPOKANE, WASH1NG10N 99260 I 15091456-3675
APPLICANT: COMPLETE NUMBERED SPACES PRESS HARD TO MAKE 3 COPIES
t~
srREErnooRESS PARCEL N0.
1. 51,414 E• S+~~F.
Lor eLocK SUBDIVISION LEGAL OESCRIPTION:
2. 1 2. 5_%l FUAGG4,j' 6mtv1M • PmlK-
pyyN~ ~ PHONE P 0 E
3 ~a
MAILING ADD;rr~m ~ Z~p Ac1ua1 SelBecks In Feet to:
- q f~~ L/ Nath 1 South I East I West
CONTRACT4R ~ UCENSE EXPIRES PHONE SiIe oi Pa►'oel Zoqe C~esaiil tion ' Reefdentlal 0
~~c
4. AOORESS ZIP T ~ OccuPancN ~Y~ ~pNo ~❑Req'd. CommercfaljD'
~
DESIGNER PHONE NawConst Va1ualion RemodeledValuallon -ietelBidg FloorAr I
Qi
5~ ADDflESS ZIP MainFtoor Upperffooro GaragefStorage Greenhouse
q-IANGE OF USE FROM 70 Cwer Deck Uncv Dedc Fin Basement Unffn Basement
~6 No 8atns No Floas No Fin Rooms No Dwellings
TYPE ❑ NEW 0 ALT 0 AD'N. 0 RPI. 0 MVE.
~ j, aF OTHER
WORK 0 BLD, ❑ PLMB. 0 MECH, Q M.H. ~ POOL c~ti~ti~~ emvt Re~qutred Yeso Nofl Nurr~
Reoefved Yes❑ No❑
DESCRIBE WORK ShaelineslFlood Hazard Plans Requtred'P5
8. 7lfp ~ YesO Not Applic )0 Recefved X
CJ VA ATION SOURCE GAS ELECTRIC WATER SEWAGE p„merohip FEES COLLECTED
PUBIIC 0 SEPTIC 0 p~blic 0 Private
9• llc~ UTIL~ITIES PRIVATE 0 SEWER 0 51
~ I hereby certily that l 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 flrdinances gaverning this ty~Q of guilding
~ work will be complfed wlth whether speciffed herein or not The granting of a permit does noi presume to give au-
thority to violate or cancel 1he rovisions of any other state or local law regulating conatructlon or the performance
of construction. SEE RE SE SI E FOR A INSPE IONS Plumbinp
SIGNATURE OF APPLICATION
OWNER OR AGENT ` , DATE Mech.
S P E C I A L APP SPEC ITIONS: (SEE REVERSE SIQE FOR NOTICE)
Plen Check
PRELIM NAl DATE
Env Health
SEPA
r ✓ Planning Moduletl
MFG Home
Rre
Prevert
Engineer Olher (SPecftY)
f
✓
UtNities
TOTAL a
SEPA WHEN MACHINE VALIOATEO IN THIS SPACE,
PERMIT iS NONTRANSfERABIE THIS BECOMES A PERMIT.
Exa"'• PERMiT iS NULL ANO VOID IF WORK HAS NOT COMMENCED
euilding IN 180 DAYS
Tech OATE ISSUED PERMIT N0.
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