1983, 07-21 Permit: 83A-6796 Attached GaragePLAN NUMBER
APPLICATION /PERMIT
SPOKANE COUNTY — DEPARTMENT:,F BUILDING & SAFETY
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456 -3675
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
1.
2.
STREET ADJRESS
9Lo fir
LOT BLOCK SUBDIVISION
4.
•
PARCEL NO. 1-794-3 - O^ `(p
OWtrk_ 1, - iAKINONA
MAILING ADDRESS
5 - 9 - 4 1 - 0 / i
CONTR CT
C-ye+Q T
ADDRESS
0 - 13
PHONE
LICENSE EXPIRES
PHONE
LEGAL DESCRIPTION:
E- 1-' o , v, 172. 1ar,
ZIP
Actual Set Backs in Feet to:
North (South?
Size f Parcel 1 „ I Zone Classifir�a�tion
' Sprinklered
❑Yes ONO ❑ Reg 'd.
Type,Ggst.
Occupancy y
East 7 ` West
Residential-El
Commercial ❑
DESIGNER
5.
ADDRESS
PHONE
ZIP
New Co t. Valuation
Main Floor
Remodeled Valuation
Total Bldg. Floor Area
Upper Floors
Garage /Storage
Greenhouse
CHANGE OF USE FROM
6.
TO
Cover Deck
Uncv. Deck
Fin. Basement
Unfin. Basement
TYPE ❑ NEW ❑ ALT. Z'AD' N. ❑ RPL. ❑ MVE.
7. OF El OTHER
WORK 'BLD. ❑ PLMB. ❑ MECH. ❑ M.H. ❑ POOL
No. Baths
No. Floors
No. Fin. Rooms
No. Dwellings
Certifi. of Exempt.
or Variance
Required Yes❑ No L;
Received Yes El No r2:
8 isc
DES iFt E V/ �®
VALUATION SOURCE GA
UTILITIES
9.
ELECTRIC
PUBLIC.Ii
PRIVATE ❑
SEWAGE
SEPTIC
SEWER ❑
i
Shorelines /Flood Hazard
Yes NotApplic. ❑
Ownership
Public ❑ Private-El
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 spe 'fled herein or not. The granting of a permit does not presume to give au-
thority to violate or cancel the proy, is '•• / of any other state or local law regulating construction or the performance
of construction. SEE REVERSE lI _ 7 O REQUIRED INSPECTIONS
VIV7/11 44/
SIGNATURE OF
OWNER OR AGENT
SPECIAL APPROVALS
PRELIM. FINAL DATE
APPLICATION
DATE
Env. Health
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
��9
SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PERMIT IS NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
Number
Plans Required .E(
Received jJ
FEES COLLECTED
Building
Plumbing
Mech.
Plan Check
SEPA
Modular/
MFG. Home
Other (Specify)
TOTAL $ 6c27
PERMIT NUMBER__
E334; —C97%go
02* *68.00
*68006
A *000 n
667.42
07 -19 -83
6.479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATEQS$UEI 1 — 8 3
PERMIT(-4.1O. 9. 6 z
*68,00 WOITI AL
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