1983, 05-02 Permit: 83A-3541 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.
3.
4.
STREET ADDRESS
. & c1 ®w M.P.
LOT
OWNER
MAILING ADDRESS
N,i30ci c. -=re, ptrJ
CONTRACTOR
dk ?KC
ADDRESS
�vA Yvl.6
BLOCK
SUBDIVISION
£ Pts T
PARCEL NO.
t aS3t--%\Zs
LEGAL DESCRIPTION:
PHONE
PHONE
c14
ZIP
aq'..(L:iC›
Actual Set Backs in Feet to: -'r (••)()
North 'South
LICENSE EXPIRES
PHONE
Size of Parcel
East
Zone Classification
West
Residential IF
Commercial 0
ZIP
Tnst.
Occupancy
Spr'nklered
❑Yes ❑No ❑Req'd.
5.
DESIGNER
PHONE
New Const. Valuation
Remodeled Valuation
Total Bldg. Floor Area
ADDRESS
ZIP
Main Floor
Upper Floors
Garage/Storage
Greenhouse
CHANGE OF USE FROM
6.
TO
Cover Deck
Uncv. Deck
Fin. Basement
Unfin. Basement
TYPE /NEW ❑ ALT. ❑ AD' N. ❑ 9PL. ❑ MVE.
7. OF
CI BLD.
WORK BLD. ❑ PLMB. ❑ MECH. M.H. ❑ POOL
❑ OTHER
No. Baths
No. Floors
No. Fin. Rooms
No. Dwellings
Certifi. of Exempt.
or Variance
Required Yes❑ NoV'
Received Yes Nor]
Number
DESCRIBE WORK
8• vVC,C.€ 1Gar ®F
i i VALUATION
Ma/ OnC,
SOURCE
UTILLIITIES
1,/\. -t .
Shorelines/Flood Hazard
Yes❑ NotApplic. 0
Plans Required 0
Received 0
GAS
ELECTRIC
WATER / SEWAGE
PUBLIC Q SEPTIC
PRIVATE ❑ SEWER ❑
Ownership /
Public 0 Private re
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
OWNER OR AGENT
SPECIAL APPROVALS
PRELIM. FINAL DATE
Env. Health
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
f4<1
APPLICATI
'4e'2 DATE
SPECIAL CONDITION (SEE REVERSE SIDE FOR NOTICE)
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/ SO. f
MFG. Home
Other (Specify)
TOTAL $ .0CD
PERMIT NUMBEE
174--1
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATE65.,60 2 -8 3
PERMIT4d. 41 z
*5 0, O 0 1OTAL