1984, 04-17 Permit 84A-3436 Storage BldgSIGNATURE OF
OWNER OR AGENT
f PLAN NUMBER
APPLICATION/PERMIT
SPOKANE COUNTY - DEPARTMENT OF BUILDING & SAFETY
N6RTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
1.
STREET ADDRESS
, 48i4-(-
LOT
2. A
BLOCK
SUBDIVISION
OWNER
3. A 2tv0c.p V—A-LA F
PHONE
PHONE
MAILING ADD ESS ZIP
��.71'(_cry L.
• q6(
CONTRACTOR LICENSE EXPIRES
4. 5r-'hr;
ADDRESS
DESIGNER
5.
ADDRESS
CHANGE OF USE FROM
PHONE
ZIP
PHONE
ZIP
TO
7 TTYPE1%IEW 0 ALT. 0 AD' N. 0 RPL. 0 MVE. ❑OTHER
WORK VBLD. 0 PLMB. 0 MECH. 0 M.H. ❑ POOL
PARCEL NO.
OSq42 , Q
LEGAL DESCRIPTION:
Actual Set Backs In Feet to:
North South
Size of Parcel
T . onst. Occupancy
East
West ). (�
Zone Classification
G
Residential
Commercial ❑
Spr nklered
❑Yes ❑No ❑Req'd.
DESCRIBE WORK
8. c-y•Z".C5f
VALUATION
9.
ew Const. Valuation
—3z
Main Floor
Remodeled Valuation
Upper Floors
Cover Deck
No. Baths
Uncv. Deck
Garage/Storage
C 72--
No. Floors
Certifi. of Exempt.
or Variance
Total Bldg. Floor Area
a-,-72.
Fin. Basement
Greenhouse
No. Fin. Rooms
Required Yes❑
Received Yes El
Non
No El
Unfin. Basement
No. Dwellings
Number
Shorelines/Flood Hazard
E t _ :_l L I f fv C Yes ❑ Not Apollo. 0
SOURCE
F
UTILITIES
GAS
ELECTRIC
Ownership
Public 0 Private ❑
herebycertify 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 REVESIDE FOR - • . IRED INSPECTION
j //
SPECIAL APPROVALS
PRELIM. FINAL DATE
Env. Health
kNiCar
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
APPLICATION / C
DATE
SPECIAL CONDITION (S'(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
Building
Plumbing
Mech.
Plan Check
SEPA
Modular/
MFG. Home
Other (Specify)
TOTAL $�'`011)
PERMIT NUMBER
E414- —
02* s61.00
.. 61.008
A *000.
3435
04.- 1 7-84
f 61.79.
CL
CO
ILI
LL
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
n QQ , •
R
DATJ UED' " 4
PERMIT4I t. 3, 6 z
*61,00 AL
s
BUILDING PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
(Please return this original and your building plans to the Department of Building and Safety)
1 (last) (first)
� Sl/�Gt�vvrf/1L 2 Project Address (not Mailin Address) a- Road Name Space
S'fr/4 -ec��
Owner's Name
(m) I Apartment Use Only
Res.
Zip
z
Comm
3 Cityl mmunity/ -J'
CjJ /K
S'tatteems
N1�
Subdivision/Plat m yy�} y %pY�j�p'.y/
5K /sA / ! '/ 11 /-cam/ /
4 r Parcel No.
,s. , 2— (��j
C?
Lot /�
.,C�
/
Block
* * * DEPARTMENT USE ONLY * * *
5 Sic Code
Zone Act. 8
Zone Project No.
6 Dwell 4
No. of Buildings
Sq. Ft./Acre
4.S OiCeitiS
Depth
Frontage
7 Set Back -Front I(L)S-1
(R)S-2 I Rear
Census Tract
Module No.
'Ini
Z
16 Architect nFirm Name
hip
Street Address
Zip
City
State
Phone
)
Contact Person
Contraptor Firm Name
N Pc
-
Zip
City
State
Phone if different than above
Street Address
Phone
)
Contact Person
8 Owner/Agent (if different than 91 abo e)
License No.
Phone If different than above
)
Business Address
9 Zip
12 Review Required
15 Type Work
City
Plan Check (Y/N)
gS
Q�Bldg
❑ Fire
❑ MH
❑ Demo
State
Phone
)
Other(Y/N) SEPA Exempt(YIN)
Irk %S
❑ Add/Alter
Replace
❑ Move
Date
❑ Other
14 Describe Work
tQ
10 Applicant Name
7
Street Address
11 Zip
Lender
City
State
Phone
(
Street Address
) 428- 0S3g
Zip
City
State
Phone
Contact Person
Additional Information
Phone if different than above
)
Application Type
(Standard unless
otherwise indicated)
Fast Track
❑ Early Start
DEPARTMENT APPROVALS
This is not a Permit
(Indicated approvals required in either "release" or "release with conditions"
space prior to permit issuance.)
Environmental Health
W. 1101 College
Room 200
Conditions/Comment
IIImo
r Residential
El New Construction; ❑ Bldg alteration/addition
Additional structure;
APPLICATION #
Release
Release
w/cord 1
Hold 2
Planning/Zoning: ❑ Commercial; ❑ Cert. of Exemption; ❑ Frontage;
N. 721 Jefferson ❑ Setbacks; ❑ lot w/d; ❑ lot size; ❑ use/zone;
❑ CU, variance, zone change; shoreline; ❑ fence;
❑ Other
Conditions/Comments
Engineers: ❑ Commercial; ❑ Residential; ❑ Flood Plain;
N. 811 Jefferson 0 drainage ❑ new access/approach; 0 fence;
❑ road improvements
Conditions/Comments-
Utilities:
N. 811 Jefferson
Conditions/Comments
Other:
Plan Exam
Fire Prey.
Conditions/Comments
Project Representative Telephone
Agencies Performing Special Inspection:
1
2
3
1 Pndlcsta: tbcve or attach conditions relative to final as built approval
2 @ndicate above or attach reasons tor hold
117
44
Ra
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