1983, 10-28 Permit: 83B-1018 Kitchen RemodelPLAN 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.
LOT
2.
BLOCK
3.
OWNER
7) ' /L
SUBDIVISION % I
• PHONE
MAILING A DRE . l
CONTRACTOR LICENSE 5XPIRES tiAL
4. ADDRESS � , t3 76 7
DESIGNER
J. ADDRESS
PHONE
ZIP
"I' Y6 tp
PARCEL NO.
LEGAL DESCRIPTION:
Actual Set Backs in Feet to:
North _South East I West
PFICKE
7cc
ZIP
Size of Parce
Zone Classification
Residential O
Commercial ❑
Type Const.
Occupancy
Spr'nklered
ElYes ❑No ❑Req'd.
CHANGE OF USE FROM
6.
PHONE
ZIP
TO
TYPE ❑ NEW ❑ ALT. ❑ AD' N. ❑ RPL. ❑ MVE.
7. OF ❑ BLD. O PLMB. ❑ MECH. ❑ M.H. ❑ POOL
WORK
❑ OTHER
New Const. Valuation
Remodeled Valuation
Total Bldg. Floor Area
Main Floor
Upper Floors
Garage /Storage
Greenhouse
Cover Deck
Uncv. Deck
Fin. Basement
Unfin. Basement
No. Baths
No. Floors
No. Fin. Rooms
No. Dwellings
Certifi. of Exempt.
or Variance
Required Yes❑ No❑
Received Yes❑ Norl
Number
DESCRIBE WORK
8.
VALUATION
9.
SOURCE
UTI LLIITI ES
GAS
ELECTRIC
Shorelines /Flood Hazard Plans Required C
Yes❑ Not Applic. ❑ Received ❑
WATER
PUBLIC ❑
PRIVATE ❑
SEWAGE
SEPTIC ❑
SEWER ❑
Ownership
Public ❑ Private ❑
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 SIDE F • R • EOUIRED INSPECTIONS
SIGNATURE OF
OWNER OR AGENT
SPECIAL APPROVALS
PRELIM. FINAL DATE
Env. Health
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
APPLICATION JJ
DATE �—
SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
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)
TOTAL $
PERMIT NUMBER
21---;t7;
*17.00
*17.006
A *0.00 8
101.72
10 -28 -83
6,479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
10-28'-83 1': L8 z
DATE ISSUED
*17,00
PERMIT NO. TOTAL