1983, 10-03 Permit: 83A-9803 MHPLAN 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
1.
2.
STREET AD KESS
169
7-1
/
BL CK
3.►GIV GE.>
MAILING ADDRESS
'616
SUBDIVISION I
{C�•'��/��� li\PvHONE PHONE
MN
4.
CONTRACTOR
ADDRESS
LICENSE EXPIRES
2-i 2 --
PARCEL NO.
LEGAL DESCRIPTION:
Actual Set Backs in Feet to: r:/(1.9111\161
/(1.' I '
North South t East
West
DESIGNER
5.
ADDRESS
CHANGE OF USE FROM
6.
TYPE .. (NEW
7. OF
WORK ❑ BLD.
PrIONE
ZIP
PHONE
ZIP
TO
❑ ALT. ❑ AD' N. ❑ RPL. ❑ MVE.
❑ PLMB. ❑ MECH. .2%H. ❑ POOL
70
8.DESCRWE reit)IiLR� t1Nt3
❑ OTHER
Size oParcel ZoneasiifiGation
40 X
Residential.Q
Commercial ❑
TypeVns
Oc?upancy
Remodeled Valuation
New Const. Valuation
Sprinklered
❑Yes ENo ❑Req'd.
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❑ Noll
Yes❑ No❑
Number
Shorelines/ Flood Hazard
Yes❑ Not Applic. E
VA AT,�II jN�y� SOURCE GAS' ELECTRIC
9. I Vl/t kTILITIES
WATER
PUBLIC Ai
PRIVATE ❑
SEWAGE
SEPTIC
SEWER ❑
Ownership
Public ❑ Private
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 specified herein or not. The granting of a permit does not presume to give au-
thority to violate or cancel the provi ns o any other state or local taw regulating construction or the performance
of construction. SEE REV : I • FO: EOUIRE •..„, ECTIONS
SIGNATURE Olr APPLICATION (.7OWNER OR AGENT�0.. -01. DATE ���� �'yr
SPECIAL APPROVALS
PRELIM. FINAL DATE
Env. Health
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
No
SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
L/k
4 '
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 $
5O
PERMIT NUMBER
07* *5000
*50006
A *000
980,22
10-03-83
z 6479
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATEJSS(1E-60 3 - 8 3
PERMIT ] 0.3 2
IVa
*5 0.0 0*OtAL