1983, 03-03 Permit: 83A-1476 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
1.
STREET ADDRESS
. I770-
LOT
2.
BLOCK SUBDIVISION
17 e ' 1IJ /6 - —1'v Ie,tJ /SC—
PHONE
PHONE
3.
D t3 I ►J \Ci4 8766
(AILING ADDRESS
132 1K
LICENSE EXPIRES
CO: ACAOR
4. ADDRESS
PARCEL NO.
LEGAL DESCRIPT`ON: i 1,4 147_, 2 �
Actual Set Backs in Feet to:
P
ice) �D
North .30 1 South _O East 6 5'4: I West
•
DESIGNER
PHONE
ZIP
ADDRESS
CHANGE OF USE FROM
6.
PHONE
ZIP
TO
TYPEW ❑ ALT. ❑ AD' N. ❑ RP . ❑ MVE.
7. OF ❑ OTHER
WORK ❑ BLD. ❑ PLMB. ❑ MECH. VM.H. ❑ POOL
Size of Parcel
7t x -
one Classification
�ZIG�
Residential i�
Commercial ❑
Type Cgnsll.
Occupancy
Sprinklered
❑Yes 0 N ❑Req'd.
NewConst Valuation
Remodeled Valuation
Main Floor
Cover Deck
No. Baths
Upper Floors
Uncv. Deck
No. Floors
Total Bldg. Floor Area
Garage /Storage
Certifi. of Exempt.
or Variance
I Required
Received
Fin. Basement
Greenhouse
No. Fin. Rooms
Unfin. Basement
No. Dwellings
Yeses No Number
Yes' No❑
I6'�-
DESCRIBE WORK
i l
SOURCE GAS — ELEC oe
F
UTILITIES
VAL TO�
9.
WATER
PUBLIC
PRIVATE ❑
SEWAGE
SEPTIC
SEWER ❑
Shorelines /Flood Hai rd
Yes NotApplic.
Ownership
Public ❑ Private
I hereby certify that I have read and examined this appl' cation 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 REVERR SIDE FOR REQUIRED INSPECTIONS
OWNER OF Ts �� J/�4 %% _ /J
OWNER OR AGENT IA/.... �il�
APPLICATION
DATE
SPECIAL APPROVALS
PRELIM. FINAL DATE
Env. Healt?i
Planning
Fire
Prevent.
4)m'
SPECIAL CONDITIONS: (SEE REVERSE SIDE F R NOTICE)
19- /44'•11\I ei Psi ' b. -rte M 1.1 -
23 C- ' v 3 Oro 2/23 /46 3 _ p4iec --
( Ls cvect4e4 "pv∎ a ✓ -JO V2, -A✓ /66 ( V _d
Co v S
\ tf\572 e4j PN V
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
5
c-c:OLa VQ Y'LC 1/41t11TiS $ ERA L644
�
V
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 7
Other (Specify)
TOTAL
as
,MIT NUMBER
\ +7
67* *50.00
*50,006
A *000
1262
02 -23 -83
6479,
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATE IOED 0
SV 8
PERMIT f7O. 7, 6
*50.00aH
TOTAL