1983, 05-04 Permit: 83A-3623 Garage AdditionPLAN NUMBER
()-2
APPLICATION/PERMIT
SPOKANE COUNTY - DEPART' ANT 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.
PARCEL NO
LT BLOCK SUBDIy SI +
2. 1V1��
OWN R PSI /
3 :i L _ / '4.0357
MAILING ADDRESS ryg�i r ZI� 'r
LICENSE EXPIRES PHOT
LEGAL DESCRIPTION:
PHONE
4.
ONTf4AG
CTQFF
ADDRESS
DESIGNER
5.
ADDRESS
CHANGE OF USE FROM
Actual Set Backs in Feet to:
North 3 ,South
East I West
ZIP
PHONE
ZIP
TO
TYPE ❑ NEW E ALT. El AD' N. ❑ RPL. ❑ MVE.
7• OF ❑ QLD. ❑ PLMB. ❑ MECH. ❑ M.H. ❑ POOL
WORK
❑ OTHER
Size of Parcel I
Il C,CJ
Zone Classification
ResidentiaL12"'
Commercial ❑
Type CpnJt.
Occupancy
tvF 1
Sprinklered
❑Yes 0 N
EReq'd.
New Const. Valuatjon
Remodeled Valuation
Total
Main Floor
Upper Floors
Garage/Storage
Cover Deck
No. Baths
Certifi. of Exempt.
or Variance
Uncv. Deck
No. Floors
Fin. Basement
Bldg. Floor Area
Greenhouse
Unfin. Basement
No. Fin. Rooms
No. Dwellings
Required Yes No❑
Received Yes No F.
Number
8.
9.
DE�WQRK
VALUATI(SN SOURCE
F
UTILITIES
GAS
ELECTRIC
WATER
PUBLIC Ad'
PRIVATE ❑
SEWAC
SEPTI
SEWER ❑
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 REV,
SIGNATURE OF
OWNER OR AGENT �•aJ/L�t:�
SPECIAL APPROVA
SIDE FOR
D INSPECTIONS
PRELIM. FINAL DATE
Env. Health
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
APPLICATION r
DATE 7_�
SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PERMIT IS NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
Plans Required❑
Received .. E/
FEES COLLECTED
Building
Plumbing
Mech.
Plan Check
SEPA
Modular/
MFG. Home
Other (Specify)
TOTAL $
oI
PERMIT NUMBER
*61.00
*61,006
A *0.00 S
56212
05—C4-83
6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATE9SSUEDo 4 — 8 3
PERMIT 1t. 2.J z
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