1984, 01-20 Permit 84A-613 MHFLAN NUM13tH
AI-PI-'L IL:A 1 ION / 1'EFITV1 IT
SPOKANE COUNTY - DEPARTMENT OF BUILDING & SAFETY
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 3 COPIES
STREET ADp S
1. ILVI U� 0 ri-614.,
2.
LOT
BLOCK
MAILINGI A�DR�SS
rtortot
COCNTAI(��/
4. "'
ADDRESS
DESIGNER
ADDRESS
CHANGE OF USE FROM
io
LICENSE EXPIRES
PHONE
PHONE
PHONE
TYPE gr<EW ❑ ALT. 0 AD' N. ❑ RPL. 0 MVE.
7. OF
WORK ❑ BLD. ❑ PLMB. 0 MECH. ,ZM.H. ❑ POOL ❑ OTHER
DES
8.
9.
RIBE WORK
SOURCE
UTILITIES
GAS
ELECTRIC
-'ram i$CG
WATER," SEWAGE/
PUBLICZ SEPTIC
PRIVATE ❑ SEWER ❑
PARCEL NO. --7
51-`/�,
O J � r.7l
LEGAL DESCRIPTION: 6�i' i or
OF:-
` 7
Actual Set Backs in Feet to:
North 1,0 !South
Sizxfprcel
New Const. Valuation
Main Floor
Z. e Classification
West Z
Residential 21
Commercial ❑
Spr nklered
❑Yes ❑No ❑Req'd.
Remodeled Valuation
Upper Floors
Cover Deck
No. Baths
Certifi. of Exempt.
or Variance
Uncv. Deck
Garage/Storage
No. Floors
Total Bldg. Floor Area
Greenhouse
Fin. Basement
No. Fin. Rooms
Required YesNoO
Received Ye ❑ No
Shorelines/Flood Hazard
Yes NotApplic. ❑
Ownership
Public ❑ Privat
I her 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
SIGNATURE OF
OWNER OR AGENT
SPECIAL APPROVALS
PRELIM. FIN L DATE
I
Env. Health
Planning
Fire
Prevent.
MKS
tik
4/6
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
APPLICATION p
DATE l 6' a
SPECIAL CO DITIONS: (SEE REVERSE SIDE FOR NOTICE)
PERMIT IS NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
Unfin. Basement
No. Dwellings
Number
Plans Required ❑
Received ❑
FEES COLLECTED
Building
Plumbing
Mech.
Plan Check
SEPA
Modular/
MFG. Home
50,
Other (Specify)
TOTAL $
PEiw NUM i 2)
02* *5000
61.2
0.1 20-84
6.479,
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATEQSSUEE D . 4 PERMIT Nd. �'
* 5 a °(4AL