1983, 10-28 Permit: 83B-1036 AdditionPLAN 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.
STREEj ADD('iESS
Z2-
LOT BLOCK
2.
OWNER
SUBDIVISION
MAILING DDRESS
N• ,2— r r
CONTRACTOR
4trJ
AtRESSj
DES yNEER.�
5. � ` I + -
AfESS V'2 A J
CHANGE OF USE FROM
727
LICENSE EXPIRES
PHONE
PH
2�
4-60
PARCEL NO. I 51 05,
LEGAL DESCRIPTION:
Actual Set Backs in Feet to:
North (South
East 2.—1
27°2
?4,7
Size ofiPar I R C)
Type C�f.t. rcy
New Const. Valuation
10 6c0
TO
TYPE .0).W ❑ ALT. .8.1(D' N. ❑ RPL. ❑ MVE.
7. OFOTHER
WORK BLD. ❑ PLMB. ❑ MECH. ❑ M.H. ❑ POOL ❑
DESCRIBE OR -i -�� Td\
VALUATION
9.
SOURCE
UTILLIITIES
GAS
ELECTRIC
WATER
PUBLIC
PRIVAT ❑
SEWAG
SEPTI d
SEWE ❑
West
Zone Classification
Residential
Commercial ❑
Spr'nklered
EYes ❑No ❑Req'd.
Remodeled Valuation
MaiFrl look (Upper Floors
Cover Deck
No. Baths
Uncv. Deck
Total Bldg. Floor Area
Garage/Storage
No. Floors
Ceriif1. of Exempt.
or Variance
Greenhouse
Fin. Basement
No. Fin. Rooms
Required Yes ❑ No❑
Received Yes No l-1
Shorelines/ Flood Hazard
Yes Not Applic. ❑
Ownership
Public ❑ Privet
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 isions of any other state or local law regulating construction or the performance
E FOR REQUIRED INSPECTIONS f
of construction. SEE EWERS
SIGNATURE OF
OWNER OR AGENT/
SI
'fin. 6L -EW
APPLICATION
#y-; DATE
SPECIAL APPROVALS
PRELIM. FINAL DATE
Env. Health y CC
/Q
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
PECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
LAc, 1'° _2Zl 17P)
PERMIT IS NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
Unfin. Basement
No. Dwellings
Number
8.
Plans Required
Received
FEES COLLECTED
Building 1
Plumbing
Mech.
Plan Check
SEPA
Modular/
MFG. Home
Other (Specify)
TOTAL
PE MIT NUMBER
-to
„9*
*102.00
*102006
*0.00
99,9f2
10�-28-83
6.479,
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATE#S51UEt2 u u 3
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