1984, 04-09 Permit 84A-3079 Additionr�IrrL1LP1 I 1v1r/ r'L1S11/11 1
SPOKANE COUNTY — DEPARTMENT OF BUILDING & SAFETY
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
PERMIT NUMBER
ig' 2 7Gr
1.
2.
APPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 3 COPIES
STREET ADDRESS
t--m4\j
LOT BLOCK SUBDIVISION
3.
QWNER
M LING DRESS
0C Cps
CONTRACT
ADD
SS
AL IJ 1 61
R �, rG+x I � 14"
DESIGNER
oov
nPHON
LICENSE EXPIRES
ADDRESS
CHANGE OF USE FROM
PHONE
PHONE
' z 14-'
PHONE
ZIP
TO
TYPE ❑ /NEW ❑ ALT. Q'AD' N. ❑ RPL. ❑ MVE.7. OF ❑OTHER
WORK l�J BLD. ❑ PLMB. ❑ MECH. ❑ M.H. ❑ POOL
DESCRIBE WORK
8.
VALUATION
9.
SOURCE
UTILITIES
GAS
ELECTRIC
PARCEL NO. 54,E 9 O
�or
LEGAL DESCRIPTION: 0 i oS I
166' ,* L4 Vz 6/ cr SE c K
Actual Set Backs in Feet to:
North I South 17/
Size of Parcel
Sox 161,
Type n t.
Occupancy
New Const. Valuati n
7 .
iq Floor Upper Floors
[East I West
neClassification
113
_Sprinkiered
EYes No ❑ Reg 'd.
Remode ed Valuation
Residential P
Commercial ❑
Total Bldg. Floor Area
Garage/Storage
Greenhouse
Cover Deck
No. Baths
Certifi. of Exempt.
or Variance
Uncv. Deck
Fin. Basement
Unfin. Basement
No. Floors
No. Fin. Rooms
No. Dwellings
Shorelines/ Flood Hazard
YesD Not Applic. ❑
Required
Received
I hereby certify that 1 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 provi 'r s of laws and ordinances governing this type of
work will be complied with wheth sp / ified herein or not. T • anting of a permit does not presume to give au-
thority to violate or cancel the • ovis • s of any • er state • 1 • al law regulating construction or the performance
of construction. SEE REV , SI • OR • . S • IONS
SIGNATURE OF
OWNER OR AGENT,
SPECIAL APPROV ' LS
PRELIM. FIN
Env. Health
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
APPLICATION i /
DATE J C7
L CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
1,1,<_. (AL,riNI 44 1,1 Lek)
PERMIT IS NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
Yes No
Yes Non
Number
Plans Required
Received
FEES COLLECTED
Building
Plumbing
Mech.
Plan Check
SEPA
Modular/
MFG. Home
Other (Specify)
TOTAL $
,
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATE
Fi09
84 PERMIT1O' .79g * 1 8 O. O O. -rAL
I 1 ct