1983, 02-24 Permit: 83A-1279 ResidencePLAN NUMBER
APPLICATION/PERMIT
SPOKANE COUNTY - DEPARTMENT OF BUILDING & SAFETY
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
STREET ADDRESS
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
1. - .Bc3
LOT
2.
BLOCK
PARCEL NO.
SUBDIVISION
3.
4.
5.
OWNER
MAILING ADDRESS
r•-1:',19....i.,+:C.-Tt.c.-)N
PHONE
PHONE
et -413-1.77-7
»S4 Q4 -Z2..
— 042:2 -
LEGAL DESCRIPTION: , C.)* or T -7
e..vriAJtrc.
ZIP
CkeVZ-C,
Actual Set in Feet to:
North South (East 1 West
CONTRACTOR
'F'•,re%•6
ADDRESS
SPr (*IA
DESIGNER
LICENSE EXPIRES
PHONE
Size of Parcel
Zone Classification
coSt.
ZIP
Occupancy
Residential ft(
Commercial C
Spr nklered
0Yes ON° Req ' d.
PHONE
flaw Const. Valuation
tft
Remodeled Valuation
Tota 1,1dg. Floor Area
Ci
ADDRESS
ZIP
Main Floor
Upper Floors
Garage/Storage
CHANGE OF USE FROM
6.
TO
Cover Deck
Uncv. Deck
C)
Fin. Basement
Greenhouse
TYPE 19/NEW 0 ALT. 0 AD' N. 0 RPL, 0 MVE.
7. OF
WORK VBLD. 0 PLMB. 0 MECH. 0 M.H. 0 POOL
0 OTHER
No. Baths
No. Floors
No. Fin..Rooms
Certifi. of Exempt.
or Variance
Required
Received
Yes0 Noe,
Yes 0 No Fr
DESCRIBE WORK
8.
VALUATION SOURCE GAS ELECTRIC WATER,
UTILITIES PRIVATE E
PUBLIC
9 .
Shorelines/Flood Hazard
Yes0 Not Apollo. D
Unfin. Basement
62 -74 -
No. Dwellings
Number
Plans Required eir
Received
SEPTIC ing
SEWAGE.. Ownership v.e/
SEWER 0 Public 0 Private
V
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 REQUIE94ISPECTIONS
SIGNATURE OF ),N
OWNER OR AGENT
e- r
APPLICATI • N
DATE
SPECIAL APPR SPECIAL CONDITION: (SEE REVERSE SIDE FOR NOTICE)
At; R.e.i- 1L.EP'Ii FOV- f4"tirk r. r-.40
ON -'4 Coivo.F rs.) IAGFrt.XF-C-DiSP
Po.PPI.Z.C.Q "4--
PRELI
FIN DATE
7. Health
Planning
Fire
Prevent.
Niergineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
42)3
3
PERMIT IS NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
FEES COLLECTED
Building
Plumbing
Mech,
Plan Check
SEPA
Modular 1
MFG. Home
Other (Specify)
TOTAL
PERMIT NUMBER
'53A -
(
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATESIU42 4 - 8 3
PERM IT1N12. 7. 9*25 8. 0 0