1983, 10-24 Permit: 83B-0774 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.
LOT BLOCK SUBDIVISION
2.
OWVER
3. D0 Y\ YI ; Cck e
MAILING ADDRESS
7 1 c\ ' le -P
PHONE
PHONE
ZIP
PARCEL NO.
LEGAL DESCRIPTION:
Actual Set Backs in Feet to:
North (South
East [ West
NTRAC R LICENSE EXPIRES
4c1414\4�> CA,titwA, J
ADDRESS
9oLt t (o '1
DESIGNER
P ONE
Size of Parcel
ADDRESS
CHANGE OF USE FROM
6.
ZIP
PHONE
ZIP
TO
TYPE (Q -W ❑ ALT. ❑ AD' N. ❑ RPL. ❑ MVE.
7. OFWORK ❑ BLD. ❑ PLMB.�CH. ❑ M.H. ❑ POOL ❑ OTHER
Type Const.
Occupancy
New Const. Valuation
Main Floor
Zone Classification
Residential ❑
Commercial Li
Spr nklered
❑Yee 7No ❑Req'd.
Remode ed Valuation
Upper Floors
Cover Deck
No. Baths
Certifi. of Exempt.
or Variance
Garage/Storage
Uncv. Deck
No. Floors
DESCRIBE WORK
8.
VALUATION
9.
SOURCE
F
UTILLIITIES
GAS
ELECTRIC
WATER
PUBLIC
PRIVATE D
SEWAGE
SEPTIC 0
SEWER ❑
Total Bldg. Floor Area
Greenhouse
Fin. Basement
No. Fin. Rooms
Required Vest: Non
Received Yes❑ Noll
Shorelines/ Flood Hazard
Yes Not Applic.
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 APPLICATION p ff �]
OWNER OR AGENT / . J / i .// /i DATE l Z 1 v
SPECIAL APPRO. LS SlirECIAL CONDITIONSr (SEE REVERSE SIDE FOR NOTICE)
r PRELIM. FINAL DATE
Env. Health
4.
Planning
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
Unfin. Basement
No. Dwellings
Number
Plans Required LJ
Received El
FEES COLLECTED
Building
Plumbing
Mech.
Plan Check
SEPA
Modular/
MFG. Home
Other (Specify)
TOTAL $
pgirr NUMBER
o -7-1y
04*
*2Q00
*20,00`
*C00
77.2.E
10-2.4—P3
a 6479
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATE hibED2 4 8 3 PERMIT N0. Z4 0
*2 0.0 U$oiAL