1983, 03-25 Permit: 83A-2265 InsertPLAN 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. S. '3�l(i )p,s-ctr-
PARCEL NO.
LOT
2.
BLOCK
SUBDIVISION
OWNER
3. \a/4 cacs_G-a
MAILING ADDRESS
5. t Lo E as
CONTRACTOR
4.
5.
4691/2v -rye
PHONE
PHONE
2tzc - /
LEGAL DESCRIPTION:
ZIP
Ci'Gl'�.CXo
Actual Set Backs In Feet to:
North (South [East I West
LICENSE EXPIRES
PHONE
Size of Parcel 1 Zone Classification
Residential 0
Commercial 0
ADDRESS
�flrnc
DESIGNER
ZIP
Type Const.
Occupancy Spr nklered
DYes ❑No ❑Req'd.
PHONE
New Const. Valuation
Remodeled Valuation
Total Bldg. Floor Area
ADDRESS
ZIP
Main Floor
Upper Floors
Garage/Storage
Greenhouse
6.
TYPE
7. OF
WORK
CHANGE OF USE FROM
TO
Cover Deck
Uncv. Deck
Fin. Basement
UnfIn. Basement
1314EW ❑ ALT. ❑/,D'N. ❑ RPL. ❑ MVE.
❑ BLD. 0 PLMB. CKMECH. ❑ M.H. 0 POOL
❑ OTHER
No. Baths
No. Floors
No. Fin. Rooms
No. Dwellings
Certifi. of Exempt.
or Variance
Required Yes❑ No❑
Received Yes❑ No❑
Number
8.DESCRIBE WORK
1.0103 1-2. V C. LYO Sc2T
VALUATION
9.
(nT2hl [
SOURCE
F
UTILITIES
Shorelines/Flood Hazard
Ves❑ Not Apollo. 0
Plans Requ red ❑
Received 0
GAS 1 ELECTRIC
WATER
PUBLIC 0
PRIVATE 0
SEWAGE
SEPTIC 0
SEWER 0
Ownership
Public 0 Private 0
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 dos 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 FOR REQUIRED INSPECTIONS
SIGNATURE OF OWNER OR AGENTt rul to ll �l y�Q APPLIDATE CATIO`J nURe11l a Ct IRAa
SPECIAL APPROVALS SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PRELIM. FINAL DATE
Env. Health
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
Q11
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)
or, -go
TOTAL $ 20 -ca
PERMIT NUMBER
93A- '2�Coj
04* *2000
*2Q006
A *000 8
22642
03.-25-83
2 6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATEQS�t;II 5 �' 9 3
PERMIT2N2. U. 5 Z
*2 a 0i 0, TAL