1983, 11-18 Permit: 83B-1837 ResidencePLAN NUMBER
724
APPLICATION/PERM IT -
SPOFCANE COUNTY — DEPART -MEW 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. _ g,I� z4
PARCEL NO. 2 2 — 0623 2.—
LOT
LOT BLOCK SUBDIVISION
2 r—) t•q M - kl(100, c
PHONE
3.
OWNER P-1 NE
4. ADDRESS
,.....t;LA kJ/sit,
_O'- )7
LICENSE EXPIRES
LEGAL DESCRIPTION:
CON ' ACTO�
Actual Set Backs in Feet to:
North vv (South
DESIGNER
5.
ADDRESS
CHANGE OF USE FROM
6.
P ONE
ZIP
PHONE
ZIP
TO
TYPE W O ALT. ❑ AD' N. 0 RPL. ❑ MVE.
7. OF WORK 'J BLD. ❑ PLMB. ❑ MECH. ❑ M.H. ElPOOL 0 OTHER
[East
(West 0
Size of Parcel ZQneClassification Residential
10 IX_ Tr:>�iCommercial ❑Type t'ot. I�1cup^any • vl Sprinklered
vN K. J✓� ❑Yes El No ❑Req'd.
New Const. V luation
Remode ed Valuation
Upper Floors
Garage/Storage
Cover Deck
No. Baths
Uncv. Deck
o
No. Floors
Certifi. of Exempt.
or Variance
9.
DESCRIBE WORK
� L kC p
SOURCE
F
UTILITIES
VALUATION
GAS
ELECTRIC
Total Bldg. Floor Area
Greenhouse
Fin. Basement
No. Fin.,Ryoms
Required Yes❑ No❑
Received Yes Nol
Shorelines/Flood Haze d
Year] Not Apollo. ❑
WATER
PUBLIC
PRIVATE 0
SEWAG
SEPTIC
SEWER ❑
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 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 AGENT
APPLICATION /7/,
DATE
SPECIAL APPROVALS
Env. Health,
PRELIM. FINAL
L,.
DATE
Planning
Fire
Prevent.
Engineer
IlT
Utilities
SEPA
Plans
Exam.
Building
Tech.
SPECIAL eONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PERMIT IS NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
Unfip. Basement
(TOG
No. Dwellings
Number
Flans Required jr.
Received ❑
FEES COLLECTED
Building
Plumbing
Mech.
Plan Check
SEPA
Modular /
MFG. Horne
Other (Specify)
TOTAL
v/(7
PERMIT NUMBER
02* *258.00
*258006
A *0.00
12972
11—C4-83
2 61179.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATE'1l J8-83
PERMIT'Ng. 3 7 2 * 2 5 8. O O 9oit'AL
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