1983, 09-27 Permit: 83A-9564 Double Wide 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
E.. igzo
BLOCK
LOT
2.
OWNER
3 Kit Tt-t
MAILING ADDRESS
SUBDIVISION
075(2;31 N AD D TO G r:i
PHONE ,r
E. i Sb<
CONTRACTOR
4. 54A ry
ADDRESS
DESIGNER
5. ADDRESS
PHONE
ZIP
PARCEL NO.
LEGAL DESCRIPTION:
LICENSE EXPIRES
PHONE
Actual Set Backs in Feet to:
North I South .4 East %Z' I West
Zone Classification
Adel
Size of Parcel
4-,e -
ZIP
Type Const.
Occupancy
e-3
Residential l
Commercial ❑
Sprinklered
❑Yes ❑No ❑Req'd.
PHONE
New Const. Valuation
Remodeled Valuation
Total Bldg. Floor Area
ZI P
Main Floor
Upper Floors
Garage /Storage
Greenhouse
CHANGE OF USE FROM
6.
r-1-0
Cover Deck
Uncv. Deck
Fin. Basement
Unfin. Basement
TYPE ICJ NEW ❑ ALT. ❑ AD' N. ❑ RPL. ❑ MVE.
7. OF El OTHER
WORK ❑ BLD. ❑ PLMB. ❑ MECH. ff�M.H. ❑ POOL
No. Baths
No. Floors
No. Fin. Rooms
No. Dwellings
Certifi. of Exempt.
or Variance
Required Yes Nap
Received Yes❑ No❑
Shorelines /Flood Hazard
Yes Not Applic. ❑
DESCRIBE WORK
8. a:W. U.A0 F v1A • k4 • ( x
VALUATION SOURCE WATER,/ SEWAGE/
PUBLIC u
OF
t SEPTIC B'
9_ ,C-j 0 UTILITIES PRIVATE ❑ SEWER ❑
1 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 RE. ERSE SIDE FOR REAt?1R D INSPECTIONS
%" / �--, APPLICATI C
SIGNATURE OF �._ DATE f / � _
OWNER OR AGENT u i. i-L _ �-'
SPECIAL APPROVALS SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PRELIM. FINAL
Env Health
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
GAS ELECTRIC
D A T E ( ( ) a
p�,� -Qw 0Q;Cts1-�.. u ve. c`PProa .
kee 6/9
Ownership
Public ❑ Private It
Building
Tech.
PERMIT IS NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
Number
Plans Required ❑
Received ❑
FEES COLLECTED
Building
Plumbing
Mech.
Plan Check
SEPA
Modular/
MFG. Home 160.
Other (Specify)
TOTAL $
PERMIT NUMBER
A
07*
* 10000
* 10000
* 100008
*000
935.58
09 -22 -83
61179
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATE`1SCg 7'83
PERMIT9N6.6 4 z * l �, O OFFAL
1.
/T
c-- I
_
I
461
x 1
/72
- 1°C34) GOAL.,
1:1 Id
7fl
OFFICE OF COUNTY ENGINEER
SPOKANE COUNTY, WASHINGTON
Date
, 19
Inter-office Communication
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SPOKANE COUNTY
ENGINEERING DEPARTMENT
MEMORANDUM OF REQUEST FOR INVESTIGATION
Date of Receipt: C.p , (ei —t Lqe I Time:
Location: 1 (� 2-O ( �1C l —t __ __—f Z ____10_L CO r
PRIORITY
NO.
Description of -Q-KiC
r wee
_mac (k — 2 S "
r 0. ,ene �4 ,n�,
r \ ��- C/�-PA,1 A.J�D V�Q
Sou1ce: �eer Phone Personal c/ Received by:
Address: F
Request Investigation by:
Telephone: 2g -6quo
Comments on Investigation:
�S ShOuLi t�� /oWCheJ /C)
PnaT f_4/3_ -)/4 u r' S' u(lit'Y
Recommendations and Action Taken:
Investigator: Date of Investigation:
Reviewed by:
(ignatur )
Date Action Taken: - 3 Main. Dist. Supv. /Foreman
nature