1983, 11-28 Permit: 83B-2060 SidingPLAN NUMBER
APPLICATION/PERMIT
SPOKANE COUNTY — DEPAYR'iMENT 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. /l' � G- l r f ((
LOT
2.
BLOCK
SUBDIVISION
OWNER
3 5 F. ( //r (/)
MAILING ADDRESS
PHONE
Ci 7917 54
PHONE
PARCEL NO.
LEGAL DESCRIPTION:
CONTRACTOR
4. ILl( L')L� -1. 1 -0 liter.
ADDRESS
�I :3(( C- 14C,/7LC /(ad
DESIGNER 4
5.
ADDRESS
LICENSE E<<PIR
7/3/.)
Actual
'//)
PHONE
2?' L/.
PHONE
Actual Set Backs in Feet to:
North 'South East I West
Size of Parcel 1 Zone Classification
Type Const.
Occupancy
New Const. Valuation
Residential ❑
Commercial ❑
Sprinklered
❑Yes ❑No ❑Req'd.
Remodeled Valuation
Total Bldg. Floor Area
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. ❑ RPL. ❑ MVE.
7. •OTHER ,
K�Cre-C C L
WORK ❑ BLD. ❑ PLMB. ❑ MECH. ❑ M.H. CIPOOL
8. 'f.Ec(>S /i��'
VALUATION SOURCE GAJ
9• `� c1
UTILITIES
F
DESCRIBE WORK
No. Baths
No. Floors
No. Fin. Rooms
No. Dwellings
Certifi. of Exempt.
or Variance
Required Yes❑ No❑
Received Yes ❑ No❑
Number
Shorelines/Flood Hazard
Yes❑ Not Applic. ❑
Plans Required ❑
Received ❑
ELECTRIC
WATER
PUBLIC ❑
PRIVATE ❑
SEWAGE
SEPTIC ❑
SEWER ❑
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-
ifhority to violate or cancel the provisions of any other state or local law regulating construction or the performance
. construction. SEE REV SE SIDESI� FOR REQUIRED PECTIONS
dir
SIGNATURE OF
OWNER OR AGENT
APPLICATION
DATE
/ 3
SPECIAL APPROVALS SPECIAL
PRELIM. FINAL DATE
Env. Health
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
ND IONS: (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/
MFG. Home
Other (Specify)
4 7
TOTAL $
PERMIT NUMBER
�> , 1066
00
7007:
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
11-28-8 3 206Oz *47,0O
DATE ISSUED PERMIT NO. TOTAL