1983, 06-29 Permit: 83A-5984 AdditionPLAN NUMBER
APPLICATION/PERMIT
_SPOKANE COUNTY — DEPim'rM'ENT 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. cJ
LOT I BLOCK
2. i
. Z3 i4
�3EST
SUBDIVISION
c rz_ _. 4 t,.1 v4- r
OWNER
3. "?o.-,,
MAILING ADDRESS
PHONE
PHONE
PARCEL NO.
2,C.0 - te,
LEGAL DESCRIPTION:
TCk
ZIP
Actual Set Backs in Feet to:
North (South .34:
East I West
CONTRACTOR
4. S RM,E
ADDRESS
17E
DESIGNER
5.
ADDRESS
LICENSE EXPIRES PHONE
CHANGE OF USE FROM
6.
ZIP
PHONE
ZIP
TO
TYPE ❑ NEW ❑ ALT. 'f,2 AD' N. ❑ RPL. El MVE.
7. OF WORK f4�BLD. LI PLMB. ❑ MECH. 17 M.H. El POOL
LI OTHER
Size of Parcel Zone Classification
-7( ,g too 12f2Ecnc+t A4L
Residential Et'
Commercial E
Type Const.
.7-/J
Occupancy 1
Sprinklered
❑Yes ENo Reg 'd.
yew Const. Valuation
14' 1
Remodeled Valuation
Total Bldg. Hoar Area
42.0
Main Floor
`1';Lo
Upper Floors
Garage/Storage Greenhouse
Cover Deck
Uncv. Deck
Fin. Basement
Unf in. Basement
No. Baths
1
No. Floors
No. Fin. Rooms
No. Dwellings
Certlfi. of Exempt.
or Variance
Required
Received
Yes El Nor"
Yes❑ Nor:
DESCRIBE WORK
8. Po -DO IT( on.)
VALUATION
9.
TO �t�S S�FNCE
Shorelines/Flood Hazard
YesEl Not Applic. ❑
SOURCE
F
UTILITIES
GAS
ELECTRIC
WATER
PUBLIC
PRIVATE ❑
SEWAGE/
SEPTIC 0--
SEWER 0
Ownership
Public 0 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 .rovisions of any othe ate or local law regulating construction or the performance
of construction. SEE REVE•SIDE FOR : QUI NSP TIONS
SIGNATURE OWNER OWNERORGENT ENT '/ DATEATIOI""
SPECIAL APPROVALS SPECIAL CONDITION
PRELIM. FINAL DATE
Env. Health
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
9k0
(SEE REVERSE SIDE FOR NOTICE)
PERMIT IS NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
Number
Plans Required 11
Received
FEES COLLECTED
Building}� jL� CX.)
Plumbing
Mech.
Plan Check
SEPA
Modular/
MFG. Home
Other (Specify)
TOTAL $
PERMITNUMBER
e501- siey
02* *10800
*1C8006
A '*0.00
5983
06-29-83
2 6479,
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATE4SUEI 9 - 8 3
PERMIT O. 8, 4 z *1 08.0 0 4dTAL
Dic a Cxcac'ating
P 0. BOX 26 - N. 5619 HARVARD ROAD • OTIS ORCHARDS. WASHINGTON 99027 - (509) 926-8348
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