1983, 05-17 Permit: 83A-4168 Enclose CarportNumber
PLAN NUMBER
APPLICATION /PERMIT
SPOKANE COUNTY — DEPARTMENT OF BUILDING & SAFETY
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456 -3675
STREET ADDRESS
LOT
2. 11
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
BLOCK
SUBDIVISION
it;
3.
OVj[N ER
Jl )t GrRJC_
PHONE
C-) 22
MAILING ADDRESS
4.
CONTRACTOR
ADDRESS
L
LICENSE EXPIRES
•
DESIGNER
ADDRESS
CHANGE OF USE FROM
PHONE
sto -zz
ZIP
PHONE
ZIP
PHONE
ZIP
TO
TYPE ❑ NEW ❑ ALT. ,,C3""AD'N. ❑ RPL. ❑ MVE.
7. OF ❑ OTHER
WORK ❑ BLD. ❑ PLMB. ❑ MECH. ❑ M.H. ❑ POOL
8. DESCRIBE WORK
VALUATION
9.
CAS.
SOURCE
UTILITIES
i s f A-Q Pc'¢i
GAS
ELECTRIC
WATER
PUBLIC ❑
PRIVATE ❑
SEWAGE
SEPTIC ❑
SEWER ❑
PARCEL NO.
21544 - CY7
LEGAL DESCRIPTION:
Actual Set Backs in Feet to:
North ( ` (South
Size of P rcel
v' x 2-r►
East 2 ' I West
Type Const. Occupancy
V —N Vti'I
New Const. Valuation
Main loot
Zone Classification
AC Sti
Residential -E1
Commercial ❑
Spr'nklered
❑Yes No ❑Req'd.
Remodeled Valuation
17(O ?�
Upper Floors
Cover Deck
No. Baths
Total Bldg. Floor Area
Garage /Storage
44c
Fin. Basement
Uncv. Deck
No. Floors
CertifI. of Exempt.
or Variance
Greenhouse
No. Fin
ooms
Required
Received
Yes ❑ No
Yes ❑ Non
Shorelines /Flood Hazard
Yes ❑ 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 her state or local law regulating construction or the performance
R
of construction. SEE REVER SIDE FOR REQUIRED INSPECTIONS
SIGNATURE OF
OWNER OR AGENT
SPECIAL APPROVALS
PRELIM. FINAL DATE
Env. Health
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
APPLICATION
DATE
SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
7t /STiNC1 P.OQ &ND s`rii,CTL eNcLzsir(CL U)R(LS -co U /3F- ,f.-
U` c)L- L11nt.ls 3' J3Q -04) GK11 -DE_ +tirr rin S Si'A)VV 4 C lrz
BU% N
co1..L4 M'1N S.
PERMIT IS NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
Unfin. Basement
No. Dwellings
Plans Required ❑
Received ❑
FEES COLLECTED
Building
Plumbing
Mech.
Plan Check
SEPA
Modular/
MFG. Home
Other (Specify)
TyTOTAL $ ��
PERMIT NUMBER
P34 -L f
02*
4167,q
05 -17 -83
6:479.
*3600ctz
*000
a.
O
C.)
W
.J
L
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATEVSSUEb1 /
83
PERMIT`NA.6.8 z
* 3 6.0 0 IPAL