1983, 09-02 Permit: 83A-8626 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
/4/0 &aat
LOT BLOC SUBDIVISION
2.
PARCEL NO.
140
OWEe lies I D. T y 1 o r
3. M ILLIIN/}GADDREj� /�
ii SiD LE/a& / ad Sec, W4
CONTRACTOR LICENSE EXPIRES
4. ADDRESS
PHONE
PHONE
P2L-9208
LEGAL DESCRIPTION: VER/4 pr oP B
S 100 ET or /Y..200FT. ' W3/,D E1(6- w 20fi
DESIGNER
5.
ADDRESS
CHANGE OF USE FROM
6.
PHONE
ZIP
PHONE
ZIP
TO
TYPE (NEW ALT. CI AD' N. El RPL. ❑ MVE.
7. OF
WORK ❑ BLD. ❑ PLMB.X.MECH. ElM.H.
❑ POOL ❑ OTHER
/re act infer in
8.
DESCRIBE WORK
VALUATION
9.
SOURCE
UTILITIES
GAS
ELECTRIC
Actual Set Backs in Feet to:
North
Size of Parcel
1South
)East I West
Zone Classification
Type Const.
Occupancy
Residential E]
Commercial 11
Spri nk lered
❑Yes ❑No ❑Req'd.
New Const. Valuation
Remodeled Valuation
Total Bldg. Floor Area
Main Floor
Upper Floors
Garage/Storage
Greenhouse
Cover Deck
Uncv. Deck
Fin. Basement
Unfin. Basement
No. Baths
No. Floors
No. Fin. Rooms
No. Dwellings
Certifi. of Exempt.
or Variance
Required
Received
Yes❑ No❑
Yes❑ Novi
Number
base rI nt y,
WATER SEWAGE
❑ SEPTIC ❑
❑ SEWER ❑
PUBLIC
PRIVATE
Shorelines/Flood Hazard
Yes❑ Not Applic..
Ownership
Public ❑ 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 IDE FOR EQUIREDJA1&P TIONS
SIGNATURE OF OWNER OR AGENT OIL,/ �GC �� DAPTEICATION P•
SPECIAL APPROVALS SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PRELIM. FINAL DATE
Env. Health
Planning I.
Fire
Prevent.
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 _.I
Received ❑
FEES COLLECTED
Building
Plumbing
Mech.
Plan Check
SEPA
Modular/
MFG. Home
Other (Specify)
TOTAL $ 2 U.
PERMIT NUMBER
14* *2000
*20.006
A *000
86252
09-06-83
2 6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
09}06-83
DATE ISSUED
862.6
PERMIT NO.
* 2 0. 0 0
TOTAL
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