1984, 03-19 Permit 84A-2341 MHPERMIT NUMBER
ArrLIVA I IVIV/ h'LKIVII I
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 ADDRESS
1. _ . I : M ,� �I
2. irg
LOTA BLO6K S1I Z BDI ISION
M j t 1-E1
OWNER PHONE
MAILING ADDRESS
-
CONT6A
4. ADDRESS
PHONE
o
LEGAL DESCRIPTION:
PARCEL NO.
LICENSE EXPIRES
DESIGNER
5. ADDRESS
CHANGE OF USE FROM
6.
22-of
PHONE
ZIP
PHONE
ZIP
TO
TYPE o NEW ❑ ALT. ❑ AD' N. ❑OF/RPL. ❑ MVE.
7 WORK 0 BLD. 0 PLMB. 0 MECH. C� M.H. 0 POOL 0 OTHER
DESCRIBE WORK
8. �vl
VALUATION
9. c363oa
SOURCE
F
UTILLIITIES
('i4*o)
GAS ELECTRIC
WATER
PUBLIC ❑
PRIVATE 0
SEWAGE
SEPTIC 0
SEWER 0
Actual Set Backs in Feet to: /
,l_ 1j
North !South � 'East West
Size of Parcel Zone Classification
t
Sprinklered
❑Yes ❑No ❑ Reg 'd.
Residential 1❑
Commercial ❑
New Const. valuation
Remode ed Valuation
Total Bldg. Floor Area
Main Floor
Cover Deck
Upper Floors
Uncv. Deck
Garage/Storage
Greenhouse
Fin. Basement
Unfin. Basement
No. Baths
No. Floors
No. Fin. Rooms
No. Dwellings
Certifi. of Exempt.
or Variance
Required Yes❑ No❑
Received Yes❑ No❑
Number
Shorelines/Flood Hazard Plans Required 0
Yes Not Applic. ❑ Received ❑
Ownership
Public 0 Private4i
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.
C l v
APPLICATION%�,�
DATE
SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
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/
MFG. Home
Other (Specify)
TOTAL $
23u.0
• WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
03-19-8-4
DATE ISSUED
PERM112N. 4.1
*5O.004AL