1983, 09-07 Permit: 83A-8676 AdditionPLAN NUMBER
c
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
C.
PARCEL NO.
\4-54-2-54:64.
LOT
2.
BLOCK
SUBDIVISION
Ur Ado -'Co Van OAto
OWNER
370f LQCLL 6�CAE-i
MAILING ADDRESS
E 1149...% D.. i c;cjA
CONTRACTOR
&.S6N ON)s-r•
4.
'nWalvc
PHONE
PHONE
td0-7701
LEGAL DESCRIPTION:
ZIP
Actual Set Backs in Feet to:
North 'South
East I West
i4 f
LIC N E EXPIRES
Li t 8`J
PHONE
Sys -s56")
Size of Parcel ,,., �(
ck o, 13 4-
Zone Clasyylf!cation
Q.1
Residential RI
Commercial 0
ADDRESS
4-644 -woe?
ZIP
QQ].01
Tz ,Const.
Occupancy
R3
riL-(
5.
DESIGNER
PHONE
Const. Valuation
Spr nklered
OYes 0No
Remodeled Valuation
—
OReq'd.
Total
Bldg. Floor Area
7A3
ADDRESS
ZIP
Main Floor
7co
Upper Floors
Garage/Storage
40�
Greenhouse
6.
CHANGE OF USE FROM
7.
TYPE ❑pIEW
OF
hie BLD.
WORK
TO
0 ALT. IAD' 0 RPL. 0 MVE.
❑ PLMB. 0 MECH. 0 M.H. 0 POOL
Cover Deck
Uncv. Deck
Fin. Basement
Lint in. Basement
0 OTHER
No. Baths
No. Floors
1.
No. Fin. Booms
Certifi. of Exempt.
or Variance
Required Yes° No
1
Received VesD No❑
No. Dwellings
Number
DESCRIBE WORK
8'hOD17( r.1 :o (2tske rice
VALUATION SOURCE GAS ELECTRIC
9.UTILLIITIES
Shorelines/Flood Hazard
VesO Not Applic. 0
Plans Required 0
Received 0
WATER
PUBLIC
PRIVATE 0
SEWA
SEPTIC
SEWER 0
Ownership
Public 0 Private I>
I hereby certify that I have read and examined this appl cation 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 spec fled herein r n't. The granting of a permit does not presume to give au-
thority to violate or canoe (he provisionof any giber st e • •cal law regulating construction or the performance
of construction. SEE RE ERSE SIDE r•RREOU1REr I •EC• •NS
SIGNATURE OF 0 C� /
OWNER OR AGENT
wissm%
SPECIAL APPROVALS \ SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PRELIM. FINAL DATE _
APPLICATION 9
DATE
Env. Health
Awe
1
Planning
Fire
Prevent.
Englneer
Utilities
SEPA
Plans
Exam.
Building
Tech.
PERMIT 1S NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
FEES COLLECTED
Building
Plumbing
Mech.
Plan Check
SEPA
Modular/
MFG. Home
Other (Specify)
.ho
TOTAL $ k�-cc)
PERMIT NUMBER
02* *1C800
86632
09-O'-83
2 6479.
WHEN
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATEVSSUEDv 7 u.
PERMITIO.7'
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