1983, 03-04 Permit: 83A-1547 ResidencePLAN NUMBER
/Il
'NpirF APPLICATION/PERMIT
SPOKANE COUNTY - DEPARTMENT OF BUILDING & SAFETY
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99280 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
1.
STREET ADDRESS
- 2-00 . '1
LOT BLOCK SU DIVISION
2. 1 1 ►��r UksuLic-(
TNARINJ Isct\CC, 66<-11 PHONE
3 MAIUNGADDRE$S�O
• 4- i56451
CONTRRACCTOR LICENSE EXPIRES
4. ADDRESS
PARCEL NO.
07 4-¢ - 2-S
LEGAL DESCRIPTION:
HONE
49
DESIGNER
PH5NE
ZIP
PHONE
Actual Set Backs in Feet to:
North 'South a' East I. West
Size of Parcel Zone Classification
=x 14Rlc—
7
Type s Qaipapc SprinkleredEN
M II r// �j �j ❑Yea GNo ❑Req'd.
New Const. Valuation Remode ed Valuation Total Bldg. Floor Area
Residential Ge
Commercial
ADDRESS
CHANGE OF USE FROM
6.
ZIP
TO
TYPE fpEW ❑ ALT. /AD' N. n RPL. ❑ MVE.
7. OFCI OTHER
WORK BLD. ❑ PLMB. CIMECH. El M.H. CIPOOL
Main Floor
Cover Deck
Upper Floors
Garage/Storage
Greenhouse
Uncv. Deck
In. Basement
Unfin. Basement
No. Baths
No. Floors
No. Fin. Rooms
No. Dwellings
Certiti. of Exempt.
or Variance
Required
Received
Yesf3/ No❑
Yeses NoE
Number
8.
DESCRIBE WORK
z,1
9.
VALUATION SOOURCE
UTILITIES
043Kioxtve
GAS ELECTRIC PUBLICWATSEWAG
R SEPTICY�
PRIVATE ❑ SEWER 0
Shorelines/Flood Hazard
Yes!_; Not Applic.
Ownership
Public 0 Private
r
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 SIDE FOR REQUIRED INSPECTIONS
SIGNATURE OF i APPLICATION 3 J
OWNEP"OR AGENT . a �.t ..�, it DATE L
SPECIAL APPROVALS
PRELIM. FINAL DATE
Env. Health
Planning
Fire
Prevent
SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
PERMIT IS NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
Plans Required 0
Received ❑
FEES COLLECTED
Building
Plumbing
Mech.
Plan Check
SEPA
Modular/
MFG. Home
Other (Specify)
TOTAL $
PERMIT NUMBER
02* *7500
*75.006
A *0.00 15,
154.61
0304-83
z 6.479
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
(�
V
(ATEc/S1EDO 4 - 8 3
PERMIT, T 7 Z
*75.00,t,L
T
0
CEMENT . 'AI 10
0
MOVIIT AS )1
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0
PLUM E.E
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