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