1983, 06-28 Permit: 83A-5874 MHr LHII NIIMbt rS
A1'F'L IGAT ION /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
LOT
2. '2_
BLOCK
SUBDIVISION
OWNER
3.
P ONE
MAILING ADDRESS
4912- NI 1 PFt-6
CON_TR CTOR
4.
ADDRESS
LICENSE EXPIRES
DESIGNER
5.
ADDRESS
CHANGE OF USE FROM
PHONE
PHONE
ZIP
PHONE
ZIP
TO
�• OF W ❑ ALT. ❑ AD' N. El RPL. ❑ MVE. OTHER❑
WORK BLD. ❑ PLMB. ❑ MECH. ❑ M.H. CIPOOL
DESCRIBE WORK
8. MGA+L
VALUATION
SOURCE
UTILITIES
(2,,c 4..4)
GAS WATER
PUBLIC
PRIVATE ❑
ELECTRIC
SEWAGE,,
SEPTIC EJ
SEWER ❑
PARCEL NO. 1 (2 5 4.3 ._ o303
LEGAL DESCRIPTION:
Actual Set Backs in Feet to:
North '2.5-4' !South 2-4- [East 2-•"' i West
Si3of Parcel
IC
one Classiication
Residential i?
Commercial ❑
Type nst' Occupancy
New Const. Valuation
Spr'nklered
❑Yes ❑No Req 'd.
Remode ed Valuation
Upper Floors Garage/Storage
Cover Deck
No. Baths
Total Bldg. Floor Area
Uncv. Deck
No. Floors
Certifi. of Exempt.
or Variance
G eenhouse
Fin. Basement
No. Fin. Rooms
Required Yes❑ No❑
Received Yes Non
Shorelines/Flood Hazard
Yes❑ Not Applic.
Ownership
Public ❑ 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 OF
OWNER OR AGENT ---1-7-/
SPECIAL APPROVALS
PRELIM. FINAL DATE
_ v. Healtr
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
APPLICATION '
/�•G� r L,.�/ DATE y jfl
SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PERMIT IS NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
Unfin. Basement
No. Dwellings
Number
Plans Required ❑
Received ❑
FEES COLLECTED
Building
Plumbing
Mech.
Plan Check
SEPA
Modular/
MFG. Home1 00
Other (Specify)
TOTAL $ ISLE
PERMIT NUMBER
J
*10000
*100.006
*0.00
587.32
06-28-83
6.479,
>-
a
W
J
LL
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATE Ib UEDPERMIT NO. 2 8— 8 7. 4 z * 1 O O.
O O TOTAL
;.- /.1 L •
Mat,'1-6
147--Nt&
2 8
52, -*
•
11\
L)4k:2
A-crs
4-
24'
1/.
2 •