1984, 03-01 Permit 84A-1774 GaragePLAN NUMBER
APPLICATION/PERMIT
SPOKANE COUNTY — DEPARTMENT OF BUILDING & SAFETY
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
PERMIT NUMBER
e4A-1-774
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
1.
STREET ADDRESS
5o4 ACAt 1
LOT
2. e-
4.
BLOCK SUBDIVISION
APPL e u'
Cam'-i iJf
MAILIN ADDRESS
glOttT4t4CTO
PHONE
LICENSE EXPIRES
PHONE
9s0 - 445 '
ZIP
}C1 0.t(
PHONE
PARCEL NO.
Iq Gs? 19°3
LEGAL DESCRIPTION:
Actual Set Backs in Feet to:
North 'South
East
lWest
Size of Parcel 1 Zone Classification
Residential$,
Commercial ❑
ADDRESS 6j2,..A00
ZIP
Type .� Co at.
v
Occupancy
I
Sprinklered
❑Yes ❑No ❑Req'd.
5.
DESIGNER
ADDRESS
PHONE
ZIP
Nevy Const. Valuation
IC;f °.3
men Floor
Remodeled Valuation
Upper Floors
Garayf4/St�o.r,age
Total Bldg. Floor Area
Greenhouse
6.
CHANGE OF USE FROM
TO
Cover Deck
Uncv. Deck
Fin. Basement
Unfin. Basement
TYPE XL,NEW
7. OF
WORK , BLD.
❑ ALT. ❑ AD' N.
❑ RPL.
0 PLMB. 0 MECH. 0 M.H.
0 MVE.
❑ POOL ❑ OTHER
NO. Baths
No. Floors
No. Fin. Rooms
No. Dwellings
Certifi. of Exempt.
or Variance
Required
Received
Yes❑
Yes ❑
No❑
No ❑
Number
Shorelines/Flood Hazard
Yes❑ Not Applic. ❑
DESCRIBE WORK f
8. $2.2,v C OAS CSC PeD
VALUATION
9, 1#b6 oa
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
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 SIDE FOR REQUIRED INSPECTIONS
SOURCE
F
UTILITIES
GAS
ELECTRIC
WATER.
PUBLICIK
PRIVATE
SEWAG
SEPTIC B.
SEWER 0
Ownership
Public 0 Private X.
SIGNATURE OF i �`.-' •r,., APPLICATION
OWNER OR AGENT 4 '"*-•''� ° ` " � DATE
Pi
SPECIAL APPROVALS
PRELIM. FINAL DATE
Env. Health
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
ptekil
SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PERMIT IS NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
Plans Required 0
Received ❑
FEES COLLECTED
Building
Plumbing
Mech.
Plan Check
SEPA
Modular/
MFG. Home
Other (Specify)
TOTAL $
40
02*• *40.00
*40006
A *0.00 0
1 77.3-9
03-01-84
6.479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATE 15SdED O 1 8 4
PERMIT 1107 7.4 z
*40.00
TOTAL
70,DG
S43,66-5
00, Oi-
2ta
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FARca_ iciss - :os
0
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