1983, 06-07 Permit: 83A-4977 ResidencePLAN NUMBER
APPLICATION /PERMIT
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.
LOT
2.
7// AZ A1
BLOCK SUBDIVISION
PARCEL NO.
OWNER
3. /)i//%4-/AYA /V ti77cy✓
MAILING ADDRESS
O. 7' Sr/i W4,Cb lie
CONTRACTOR
4. 7/r179e
ADDRESS
PHONE
PHONE
y6 97 7
ZIP
LEGAL DESCRIPTION:
467- -71 ,/ceRr rNE 4". 5Y., yz ,a-A,0 Exc r
A'. /25 OA= 1,4; ,J /TC/M /3Q/V
LICENSE EXPIRES PHONE
DESIGNER
5. ADDRESS
CHANGE OF USE FROM
6.
ZIP
PHONE
ZIP
TO
TYPE NEW ❑ ALT. ❑ AD' N. ❑ RPL. ❑ MVE.
7. ❑OTHER
WORK C�lBLD. ❑ PLMB. ❑ MECH. ❑ M.H. ❑ POOL
Actual Set Backs in Feet to:
North 'South 3� /
Size of Parcel
Type Const. Occupancy
East I West
Zone Classification
Ae,r.t
Cl/ /
Residential
Commercial ❑
Sprinklered
❑Yes 0 N ❑Req'd.
N Const. Valuation
9/7
Main Floor
Cover Cover Deck
Remode ed Valuation
Upper Floors
Garage /Storage
Total Bldg. Floor Area
9/
Greenhouse
Uncv. Deck
Fin. Basement
No. Baths
No. Floors
Certifi. of Exempt.
or Variance
Required
Received
No. Fin. Rooms
Yes E No
Yes El No[
Unfin. Basement
No. Dwellings
Number
DESCRIBE WORK
8.
VALUATION
9.
SOURCE
F
UTILITIES
GAS
ELECTRIC
WATER
PUBLIC
PRIVATE ❑
SEWAGE /
SEPTIC rd
SEWER ❑
Shorelines /Flood Hazard
Yes Not Applic. ❑
Ownership
Public ❑ Private 43
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 REOU_ ED INSPECTIONS
SIGNATURE OF
OWNER OR AGENT
APPLICATION W7 /�/
DATE L v
SPECIAL APPROVALS SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PRELIM. FOAL DATE sEc,, Z�A 3l7-40%7S
Env. HeaIi
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
PERMIT IS NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
Plans Required Q'
Received [ °
FEES COLLECTED
Building
Plumbing
Mech.
Plan Check
SEPA
Modular/
MFG. Home
Other (Specify)
TOTAL $�'� ®�
PERMIT NUMB:
5800
*25800S
*0.00 L9
497.42
06 -C7 -83
64.79.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATE F$9UEt70 7 -0 3
PERMITAQ. 7. 7 z * 2 5 8' 0 0 '1.,L