1983, 05-05 Permit: 83A-3679 AdditionPLAN 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.
'l19 /A\%
L93
2.
OW
BLOCK
JJ
ER
3 'CJ
MAILING ADDRESS
_. H � L)K
SUBDI \'I IO I-
PHONE
CONTRACTOR
> 17
4. ADDRESS
LICENSE EXPIRES
1,2g- 077
PHONE
PARCEL NO.
2711.4— -- 10-7
LEGAL DESCRIPTION:
Actual Set Backs in Feet to:
North ISouth
ZIP
DESIGNER
5. ADDRESS
PHONE
ZIP
Size of Parcel
;717) +
i
Occu nType Cosi
New Co /nst, V�luatio/
Main tFloorr� Lr17 />
East I West
one Classifilation
Residential
Commercial ❑
Sprinklered
Yes ❑No ❑Req'd.
Re "7 r 00 lion
•17
Total Bldg. Floor Area
Upper Flogs
Garage /Storage
Greenhouse
CHANGE OF USE FROM
6.
TO
Cover Deck
Uncv. Deck
Fin. Basement
Unfin. Basement
TYPE ❑ N W ❑ ALT. .Li AD' N. ❑ RPL. ❑ MVE.
7. OF
WORK BLD. ❑ PLMB. ❑ MECH. El M.H. ❑ POOL
❑ OTHER
No. Baths
No. Floors
Certif1. of Exempt.
or Variance
No. Fin. Rooms
Required Ye ,07-
Received YesV Non
No. Dwellings
DESCRIBE WORK
8. Iii 00\
VALUATION
9.
SOURCE
UTILLIITIES
GAS
Shorelines /Flood Hazard
Yes Not Applic. ❑
qt6 r
Plans Required
Received or
ELECTRIC
WATER
PUBLIC
PRIVATE ❑
SEWAGE,
SEPTIC Q
SEWER
Ownership
Public O Private dr
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 REVERSE SID'' OR REQUIRED INSPECTIONS
SIGNATURE OF U %J APPLICATION C�
OWNER OR AGENT DATE
SPECIAL APPROVALS SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PRELIM. FINAL DATE
Env. Health
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
- Not artpt 1v.91 gDR_
f' 3 YIOcecx 4., - cvi/�i ! c'ra�l iiac, yo.,
u / /<<4-�� >� a i� V - 1L.,
PERMIT IS NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
FEES COLLECTED
Building
Plumbing
Mech.
Plan Check
SEPA
Modular/
MFG. Home
Other (Specify)
156,
TOTAL $ 7
PERMIT NUMBER
02* *15600
*156006
A *0.00 8
367,7
05-05-83
z 6.479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATE 04ED Q 5 8 3 PERMIT I OU 7.9 z *15 6. - -TOTAL
N9
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PAR04 -4 111/MBrn,
2'75W— /No 7
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