1983, 02-02 Permit: 83A-793 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
STREET ADDRESS
1. V103
SUBDIVISION
Ct1 rt% %1PDiTiO 14
LOT
2. (j
BLOCK
OWNER
MAILING ADDRESS
, 1C(t1 i.F�cat -
CONTRACTOR
4. 5av►ti6'
ADDRESS
S /)r e
DESIGNER
5. ADDRESS
PHONE
PHONE
C
PARCEL NO.
zc', *41- 040B
LEGAL DESCRIPTION:
ZI1'
Actual Set Backs in Feet to:
North I South Z—Od
LICENSE EXPIRES
PHONE
ZIP
Size of Parcel
140KZ,c- A 199112cDot
Type Const. Occupancy
[East I West 60'
Zone Classification
Residential vl
Commercial ❑
Sprinklered
❑Yes ❑No Reg 'd.
PHONE
New Const. Valuation
Z? ,
Remodeled Valuation
Total Bldg. Floor Area
41-t'U
ZIP
Main Floor
i
Upper Floors
Garage /Storage
Greenhouse
CHANGE OF USE FROM
6.
TYPE LoJ NEW
7. OF ❑ BLD.
WORK
TO
Cover Deck
Uncv. Deck
Fin. Basement
Unfin. Basement
❑ ALT. ❑ AD' N. ❑ //RPL. ❑ MVE.
❑ PLMB. ❑ MECH. Q"M.H. ❑ POOL
❑ OTHER
No. Baths
No. Floors
Certifi. of Exempt.
or Variance
No. Fin. Rooms
4
Required 'lest: No/7
Received Yes CI No
No. Dwellings
Number
Shorelines /Flood Hazard
Yes El NotApplic. ❑
DESCRIBE WORK Z4 (O')
8. 'Day ±.i:... �[� .0e (,
VALUATION
9-.1Z-,€), l
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 SE SIDE F R REOUIR D INSPECTIONS
SIGNATURE OF P
OWNER OR AGENT
SOURCE
UTILITIES
GAS
ELECTRIC
WATE
PUBLIC
PRIVATE ❑
SPECIAL APPROV
PRELIM. FINAL DATE
'NW 145
EnYay. nnFjealth
Plnning
Fire
Prevent.
Eyjneer
Utilities
21
SEPA
Plans
Exam.
Building
Tech.
SEWAGg /
SEPTIC Cad'
SEWER ❑
Ownership
Public ❑ Private C�
Plans Required ❑ •
Received ❑'
DATECATION� -
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 #7 1 00. O°
Other (Specify)
TOTAL $ (00.00
PERMr r NUIVBER
07* *10000
*100006
A *0.00
158,22
12 -02 -82
2 6.479
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATE Ifpl 0 2 -8 3
PERMIT NO? 9.3 z * 1 0 0 0 OTbTAL
z.