1983, 01-20 Permit: 83A-0502 FixturesPLAN NUMBER
APPLICATION /PERMIT
SPOKANE COUNTY - BUILDING CODES DEPARTMENT
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456 -3675
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
JOB ADDRESS
3
LOT
OWNER
BLOCK SUBDIVISION
RESS
✓ 6?/ , rt-r/ e1,4)
CON *•CTOR
PHONE
74,2g 1414ric■
ZIP
17G).;77
PHONE
LEGAL DESCRIPTION — SEE ATTACHED
PARCEL NUMBER /S
Actual Set Backs in Feet
North (South 'East 'West
Size of Parcel
ZIP
Type Const.
Occupancy
DESIGNER
ADDRESS
CHANGE OF USE FROM
6.
TYPE
7. OF
WORK
PHONE
ZIP
Valuation
Main Floo
TO
NEW ❑ ALT. ❑ AD'N. ❑ RPL. ❑ MVE.
❑ BLD. t›C‘PLMB. ❑ MECH. ❑ M.H. ❑ POOL
❑ OTHER
DESCRIBE WORK
VALUATION
9.
SOURCE
OF
UTILITIES
GAS
ELECTRIC'
WATER
SEWER
Upper Floors
Area of Decks
No. Baths
Zone Classification
Sprinklered
Dyes ❑No ❑ Req'd.
Building Area in Sq. Ft.
Garage Area
Storage
Finished Basement Unfin. Basement
No. Stories
CERTIFICATE
of EXEMPTION
Enum. Dist.
No. Rooms
Req'd.
Location (Area)
Ownership
Public ❑ Private ❑
USE CODE
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 authority to violate or cancel the provisions of any other state or local law reg n f onstruction or the
performance of construction. SEE REVERSE SIDE FOR REQUIRED INSPECTIONS
DATE OF APPLICATION / /1.7/g28
SIGNATURE OF APPLICANT
SPECIAL APPROVALS
NAME DATE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
SPECIAL CONDITIONS:
g
3 r-A,,+e .-
- a
611-b(l r
1v6 rvi
I
iatiLid (ice %r
yi4tia
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
No. of Dwellings
Rec'd. Not Req'd.
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
(fig
TOTAL $ ( -
PERMIT NUMBER
03* *53.00
*53006
A *000
5012
01 -20 -83
2 6/179.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
01 2 0 =8 50.2 z
*53.00 °�.
DATE ISSUED PERMIT NO. TOTAL