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1984, 02-16 Permit 84A-1330 Single WidePLAN NUMtittt RrrLIwH I IUP1/ rt.1111111 1 SPOKANE COUNTY - DEPARTMENT OF BUILDING & SAFETY NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675 PERMIT NUMB H APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES STREET ADDRESS 1. IC) 2v Ni„i (LLD OT BLOCK SUBDIVISION 2. z _iNS ,RDF1 MOBitie IkonnE 00(4'- OWNER 3. ("LJ — ROU I.G MAILING ADDRESS CONTRACTOR LICENSE EXPIRES 4. ADDRESS PHONE PHONE ZIP 't it)6 DESIGNER 5. ADDRESS PHONE ZIP PHONE PARCEL NO. LEGAL DESCRIPTION: Actual Set Backs In Feet to: North 'South Size of Parcel East West Zone Classification Type Const. Occupancy New Const. Valuation Residential 0 Commercial ❑ Sprinklered ❑Yes ❑No ❑ Reg 'd. Remode ed Valuation Total Bldg. Fioor Area ZIP Main Floor Upper Floors Garage/Storage Greenhouse CHANGE OF USE FROM 6. TO Cover Deck Uncv. Deck Fin. Basement Unfin. Basement TYPE X.NEW 7. WORK +❑ BLD. 0 PLMB. 0 MECH. �M.H. 0 POOL W 0 ALT. 0 AD'N. 0 RPL. ❑ MVE. ❑ OTHER No. Baths No. Floors No. Fin. Rooms No. Dwellings Certifi. of Exempt. or Variance Required Yes ID No❑ Received Yes No El Number 8 DESCRIBE WORK / r " VALUATION 9. SOURCE UTILITIES GAS ELECTRIC WATER PUBLIC 0 PRIVATE 0 SEWAGE SEPTIC 0 SEWER 0 Shorelines/Flood Hazard Plans Required ❑ Yes Not Appllc. 0 Received 0 Ownership Public 0 Private 0 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 REQUIR + INSPECTIONS SIGNATURE OF OWNER OR AGENT 9 /142-) DATE APPLICATION/ / dypv SPECIAL APPROVALS SP JFOfAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE) PRELIM. FINAL DATE Env. Health Planning Fire Prevent. Engineer Utilities SEPA Plans Exam. Building Tech. "YA PERMIT IS NONTRANSFERABLE PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED IN 180 DAYS FEES COLLECTED Building Plumbing Mech. Plan Check SEPA Modular 1 MFG. Home . 1 Other (Specify) �L07) TOTAL $ FIIFPflPY WHEN MACHINE VALIDATED IN THIS SPACE, THIS BECOMES A PERMIT. DATE9SZEDl 6 - 8 4 PERMIT14 3, 0 Z * 5 0, 0 0 Jib, A