1984, 04-09 Permit 84A-3141 MHMrrLI'.►H 1 IUIV f LKMY1I I
SPOKANE COUNTY — DEPARTMENT OF BUILDING & SAFETY
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
STREET ADDRESS
1.
LOT
2.
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
5 iIC,zQ Mrs.F1E D
BLOCK
SUBDIVISION
3.
4.
5.
ADDRESS
OWNERt)lY(MP C. QO`{p
MAILING ADDRESS
, 13110 N i)&ON
CONTRACTOR
ADDRESS
DESIGNER
frchn
CHANGE OF USE FROM
TYPE /!;E(.44Evv
7. OF
WORK ❑ BLD.
8.
9.
DESCRIBE WORK
VALUATION
PHONE
LICENSE EXPIRES
TO
PHONE
P az -09 13
ZIP
PHONE
PHONE
ZIP
0 ALT. 0 AD' N. 0 RPL. ❑ MVE.
0 PLMB. 0 MECH. 0 M.H. 0 POOL ❑OTHER
PARCEL NO.
LEGAL DESCRIPTION:
Actual Set Backs in Feet to:
North 'South [East I West
Size of Parcel
New Const. Valuation
Cover Deck
No. Baths
Zone Classification
Residential 0
Commercial 0
Sprinklered
❑Yes ❑No ❑Reg'd.
Remode ed Valuation
oper Floors Garage/Storage
Uncv. Deck Fin. Basement
No. Floors
No. Fin. Rooms
Total Bldg. Floor Area
Greenhouse
Basement
No. Dwellings
Certif I. of Exempt.
or Variance
Required Yes❑ No❑
Received Yes❑ No0
Number
1 06,cE W ( per N1013 Utz- Y► E
SOURCE
F
UTILITIES
GAS
ELECTRIC
WATER
PUBLIC ❑
PRIVATE 0
SEWAGE
SEPTIC ❑
SEWER 0
Shorelines/Flood Hazard
Yes Not Apollo. ❑
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 REQUIRED INSPECTIONS
SIGNATURE OF
OWNER OR AGENT
SPECIAL APPROVALS
PRELIM. FINAL DATE
Env. Health
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
APPLICATION 1/
DATE
SPECIAL COND IONS: (SEE REVERSE SIDE FOR NOTICE)
1
PERMIT IS NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
Plans Required 0
Received 0
FEES COLLECTED
Building
Plumbing
Mech.
Plan Check
SEPA
Modular/
MFG. Home
Other (Specify)
5o.—
o0
TOTAL $ "`
PERMIT NUMBER
8ffE4 - 3 !4
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATEr E U 7— u 4
a
PERMIT Of 1 1 1 z
fi tr 0 J