1984, 02-09 Permit 84A-1127 SidingHrrL1�H 1 IVIV/ r''tKIYII 1
SPOKANE COUNTY — DEPARTMENT OF BUILDING & SAFETY
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
PERMIT NUMBER
/A-Iiz7
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
1.
2.
STREET ADDRESS
G, IL �, 's5,on
LOT BLOCK SUBDIVISION
PARCEL NO.
LEGAL DESCRIPTION:
OWNER
3. TerrLF L. Bol'SC..
MAILING ADD ESS y
� r SL� fwd '5 or)
CONT ACT R
4. Nurilrw Bu rs
ADD SS jot, Airril ate_
DESIGNER
PHONE7
6 4- 54 7'g
LICENSE EXPIRES
5//7/S14
PHONE
ZI
/ (G North 'South
Actual Set Backs in Feet to:
PHONE Size of Parcel
(1.,?8— 46,86
zip
Type Const.
Occupancy
East
West
Zone Classification
Residential ❑
Commercial ❑
Sprinklered
❑Yes ❑No ❑Req'd.
ADDRESS
CHANGE OF USE FROM
6.
TO
TYPE ❑ NEW
7. OF
WORK ❑ BLD.
PHONE New Const. Valuation
ZIP
❑ ALT. ❑ AD'N. RPL. ❑ MVE.
OTHER
❑ PLMB. ❑ MECH. ❑ M.H. E POOL
Remode ed Valuation
Total Bldg. Floor Area
Greenhouse
Unfin. Basement
Main Floor
Upper Floors
Garage/Storage
Cover Deck
Uncv. Deck
Fin. Basement
NO. Baths
No. Floors
No. Fin. Rooms
No. Dwellings
Certifi. of Exempt.
or Variance
Required Yes❑ No❑
Received Yes❑ No
Number
DESCRIBE WORK
8.
VALUATION,)
9' .26ID5
Sf .2t-i 5 I'd -ir Cl
SOURCE GAS
UTILLIITIES
ELECTRIC
WATER
PUBLIC E
PRIVATE ❑
SEWAGE
SEPTIC
SEWER E
Shorelines/Flood Hazard
Yes Not Applic. ❑
Ownership
Public ❑ Private ❑
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 INSPECT ONS
SIGNATURE OF
OWNER OR AGENT
SPECIAL APPROVA S
PRELIM. FINAL DATE
Env. Health
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
APPLICATION
DATE
SPECIAL CONDIT NS: EE REVERSE SIDE FOR NOTICE)
PERMIT IS NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
Plans Required ❑
Received ❑
FEES COLLECTED
U l
Building
Plumbing
Mech.
Plan Check
SEPA
Modular/
MFG. Home
Other (Specify)
TOTAL $
-17 Qe-
*47.00
*47.006
*0,00 0
126g
02-09-84
6479,
O.
0
W
J_
U.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATE FS JEDU 9 - 4
PERMITLJ 2.7
*4 7.0 0,.F,,L