1983, 07-26 Permt: 83A-6955 AdditionPLAN NUMBER
APPLICATION/,PERMIT
SPOKANE COUNTY — DEPARTMENT OF BUILDING & SAFETY
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3875
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
STREET ADDRESS
1.
2.
OWNER
3tte En)
MAILING ADDRESS
S•'A
CONTRACTOR
` ante
ADDRESS
DESIGNER
4.
5.
LOT
BLOCK
S. 4-00°tt o .no.su
PARCEL NO.
3.3544-403c
SUBDIVISION
Mel KtW/i q
PHONE
PHONE
C12-1-152,00
LEGAL DESCRIPTION:. eo 77F NWV..0ev Se '/4
SEC, 3or E t ZC,' S. GK c_02._ "c1-1
5 .t40' . 14o'3can 'To-P-O:g.
Actual Set Backs in Feet to: `/
Nath 20 I South IJ (East
Zone Classification
ic,ot .. -1
ZIP
cicL') cr.
LICENSE EXPIRES
PHONE
Size of Parcel
190' Soo
west 7
Residential id
Commercial 0
ZIP
Type Const.
Oaupancy
1/M (
Spr nklered
❑Yes ONo ❑Req'd.
PHONE
ADDRESS
ZIP
Const. Valuation
P4s04
Main F�oor
Remodeled Valuation
Total Bldg. Floor Area
.i3
Upper Floors
6.
CHANGE OF USE FROM
TO
Cover Deck
Uncv. Deck
Garage/Storage
S17
Greenhouse
Fin. Basement
Unfin. Basement
TYPE p NEW ❑ ALT. IW D'N.
7. OF EI/
WORK BLD. ❑ PLMB. 0 MECH.
❑ RPL.
❑ M.H.
❑ MVE.
❑ POOL
0 OTHER
No. Baths
No. Floors
Corti, i. of Exempt.
or Variance
f- Required
Received
No. Flo. Rooms
No. Dwellings
Yes❑ NoN
Yes❑ No❑
Number
Lr
DESCRIBE WORK
6' A0o1"� t r7 rel 'To
VALUATION SOURCE
9• UTILITIES
GAS
ELECTRIC
W ITER
PUBLIC 0
PRIVATE 0
)SEWAGE /
SEPTIC IT
SEWER 0
Shorelines/Flood Hazard
Yes Not Apollo. 0
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 REVERSE SIDE FOR REQUIRED INSPECTIONS
SIGNATURE /%
OWNER OR AGENT ;�/�^
SPECIAL APPROVALS
PRELIM. FINAL DATE
x Env. Health
r ,Planning
Vuci
745
Fire
Prevent.
Engineer
Utilities
3EPA
Plans
Exam.
Building
Tech.
ULA
APPLICATION z
DATE
SPECIAL CONDITIONS: (SEE • EVERSE SIDE FOR NOTICE)
PERMIT 15 NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
Plans Required 0
Received 0
FEES COLLECTED
Building
Plumbing
Mech.
Plan Check
SEPA
Modular/
MFG. Home
Other (Specify)
TOTAL $ CO
PERMIT NUMBER
6-3/''6 SS
02* *61.00
*61.006
A *0.00 8
69542
07-26-83
2 6479.
WHEN
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATE ISSUED
6i95.5= *.610024
PERMIT NO.' TOTAL
i ,f•
r
°O
Za
ER6T14c, SAg$i / .� C )
PP.otoria ADD TC mu)
27
.65: 'b. ftiG+.
n 5.