1983, 05-09 Permit: 83A-3770 FixturesPLAN NUMBER
APPLICATION /PERMIT
SPOKANE COUNTY - DEPARTMENT OF BUILDING & SAFETY
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456 -3675
1.
APPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 3 COPIES
STREET ADDRESS
l7`��
BLO K SUBDIVISION
LOT
2.
OWNER
3. {�i` t- - tJ VOLD
MrG 7 i9 "‘'14--1
CONJRQC
4. ADDRESS
Pefit 667
PHONE
PARCEL NO.
LEGAL DESCRIPTION:
LICENSE EXPIRES
PHONE
Actual Set Backs in Feet to:
North [South [East `West
Size of Parcel 1 Zone Classification
Residential ❑
Commercial ❑
ZIP
Type Const.
Occupancy
Spr'nklered
❑Yes No ❑Req'd.
DESIGNER
5.
ADDRESS
PHONE
New Const. Valuation
Remode ed Valuation
Total Bldg. Floor Area
ZIP
Main Floor
Upper Floors
Garage /Storage
Greenhouse
6.
CHANGE OF USE FROM
TO
Cover Deck
Uncv. Deck
Fin. Basement
Unfin. Basement
7.
TYPE/
OF ❑ BLD.
WORK
❑ ALT. ❑ AD' N. ❑ RPL. ❑ MVE.
RS PLMB. ❑ MECH. ❑ M.H. ❑ POOL
❑ OTHER
No. Baths
No. Floors
No. Fin. Rooms
No. Dwellings
Certifi. of Exempt.
or Variance
Required Yes ❑ No
Received Yes❑ Noll
Number
8.
9.
DESCRIBE W
VALUATION
Pcid
SOURCE
F
UTILITIES
GAS FELECTRIC
WATER
PUBLIC ❑
PRIVATE ❑
SEWAGE
SEPTIC ❑
SEWER ❑
Shorelines/ Flood Hazard
Yes NotApplic. ❑
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 viollte or cancel the provisions of any other state or local law regulating construction or the performance
of construction. SEE RE .j RSE DE F. •,g. UIRED INSPEC Jo S
��.!/ ! ✓fat/ ALY
SIGNATURE OF
OWNER OF, AGENT
SPECIAL APPROVALS
PRELIM. FINAL DATE
Env. Health
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
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
Plans Required ❑
Received ❑
FEES COLLECTED
Building
Plumbing
Mech.
Plan Check
SEPA
Modular/
MFG. Home
Other (Specify)
TOTAL $
PERMIT NUM —ER
7770
*25.00
*25006
*0.00 8
37692
05 -09 -83
2 6479,
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATEQSUED" 9 _ 8 3
PERMIT1O. 7. 0 5 * 2 5, 0 0 $OIrAL
P.L. -
L,K.4 s`,''= is-1!
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