1983, 12-05 Permit: 83B-2264 Replace MHPLAN 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. a . 1`1 Zvy-.
LOT BLOCK
2.
SUBDIVISION
OWNER
3. ■t icvvy
MAILING ADDRESS ZIP
C71C..
PHONE
PHONE
4.
,- tz6 <{-
CONTRACTOR
riAY1/1l�
ADDRESS
DESIGNER
LICENSE EXPIRES
PHONE
PARCEL NO.
is533- c733t
LEGAL DESCRIPTION:
Actual Set Backs in Feet to: €.?(tS 1 NC,
North 'South I East
Size of Parcel
5. ADDRESS
CHANGE OF USE FROM
TYPE ❑ NEW
7. OF ❑ BLD. ❑ PLMB. ❑ MECH. ❑ M.H. ❑ POOL
WORK
ZIP
Type Co. nst.
PHONE
ZIP
TO
❑ ALT. ❑ AD' N. ❑ RPL. ❑ MVE.
❑ OTHER
Occupancy
Cover Deck
No. Baths
Certifi. of Exempt.
or Variance
West
Zone Classification
Residential
Commercial ❑
Spr'nklered
❑Yes ❑No ❑ Reg 'd.
Remodeled Valuation
Garage /Storage
No. Floors
Total Bldg. Floor Area
Greenhouse
Fin. Basement
No. Fin. Rooms
Required Yes El No E(
Received Yes El No El
DESCRIBE WORK
• jRC'‘A— AC,[
VALUATION
9.
M. b
SOURCE
OF
UTILITIES
GAS
ELECTRIC
14 4( 7c)
WATER
PUBLIC ❑
PRIVATE ❑
SEWAGE
SEPTIC (
SEWER ❑
Shorelines /Flood Hazard
Yes El 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 violate or cancel the provisions of any other state or local law regulating construction or the performance
of construction. SEE REVE E SIDE FOR REQUIRE ' INSPECTIONS
SIGNATURE OF
OWNER OR ACEN
SPECIAL APPROVALS
PRELIM. FINAL DATE
Env. Health
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
N�f"c
Plans
Exam.
Building
Tech.
APPLICATION
DATE
SPECIAL CONDITI • S: (SEE REVERSE SIDE FOR NOTICE)
• j) &-c (W- -IC.t'J l tti F 1
PERMIT IS NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
Unfin. Basement
No. Dwellings
Number
Plans Required ❑
Received ❑
FEES COLLECTED
Building
Plumbing
Mech.
Plan Check
SEPA
Modular/ s
MFG. Home Q
Other (Specify)
TOTAL $
PERMIT NUMBER
B3 --��
0-7
ZZG.3- Sb.baC)C.
d
0
W
-J
LL
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATE JS I'b0 5 - 8
PERMIT%l 2 6, 4 z * 5 0, 0 0
TOTAL
•
Sl
j
,tom' *
�-
VtJ
I
3 /
/1/
L (