1983, 04-11 Permit: 83A-2821 ResidencePLAN NUMBER
— —7
APPLICATAN/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
1. //3/5
LOT
2. 3
BLOCK
ac g
SUBDIVISION
FA, --.e - -'-
OWNER
3. »/MA `.4 ()N5T
PHONE
MAILING ADDRESS
5. 520Se/Nd'' 0/C
CONTRACTOR
4.
mF
ADDRESS
LICENSE EXPIRES
DESIGNER
5. ADDRESS
P ONE
—e:}:Ni
ZIP
PHONE
ZIP
CHANGE OF USE FROM
PHONE
ZIP
TO
TYPE [.V NEW ❑ ALT. 0 AD' N. 0 RPL. ❑ MVE.
7. OF
WORK [ErBLD. 0 PLMB. 0 MECH. 0 M.H. 0 POOL 0 OTHER
PARCEL NO. �} _
Q955 2 `/�J03
LEGAL DESCRIPTION:
Actual
North
Set Backs in Feet to:
1South�. 2 East
Size of Parcel
Se/ x /.45
Type Const.
Occupancy
R
New Const. Valuation
Cover Deck
No. Baths
DESCRIBE WORK
8. S7/A.0-/..E" 1' A-
VALUATION
9.
SOURCE
F
UTILITIES
GAS
ELECTRIC
WATER
PUBLIC
PRIVATE 0
SEWAGE
SEPTIC
SEWER ❑
Certifi. of Exempt.
or Variance
West
Zone Classification
Residential [9'
Commercial 0
Spr'nklered
OYes ONo ❑Req'd.
Remodeled Valuation
Total Bldg. Floor Area
ql2
Garage/Storage
No. Floors
Greenhouse
Fin. Basement
Required Yes❑ No C(
Received Yes El No❑
Shorelines/Flood Hazard
Yes❑ Not Applic. ❑
Ownership
Public 0 Private 0
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?,
APPLICATION i`6 -M
CA
SPECIAL APPROVALS
PREL$V1. FINAL DATE
Env. Health
7ctFl(l)�f)
Planning
46.
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
AN Ce..rCtLL PERMIT IS NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
No. Dwellings
Number
Plans Requ red Q'/
Received Cg'
FEES COLLECTED
Building
Plumbing
Mech.
Plan Check
SEPA
Modular/
MFG. Home
Other (Specify)
TOTAL $
PERMIT NUMBER
J2* *25800
*258006
A *0.00
26202
04-05-83
6G79.
0
O
W
-1
u -
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATE'ISSUED1 1 - 8 3
PERMIT2NO. 21 z* 2 5 8. O O 9'dI AL
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