1983, 06-28 Permit: 83A-5872 MHPLAN NUMBER
C
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.
STREETIADDRESS
N r 6u
LOT BL CK SURQqIVISION
2. 14-41LL- ,'
3. '�1H 1.1ti'k
MAILING ADDRESS
�* 1'- 1 FL
PHONE
.21 17
PHONE
CONTRT
4. ADDRESS
57
LICENSE EXPIRES
DESIGNER
5.
ADDRESS
CHANGE OF USE FROM
PHONE
ZIP
PHONE
ZIP
TO
TYPE /JEW ❑ ALT. ❑ AD' N. ❑ RP . ❑ MVE.
% WORK ❑ BLD. ❑ PLMB. ❑ MECH. H. ❑ POOL OF ❑OTHER
DESCRIBE WORK
8. MLe.
VALUATION
9.
SOURCE
UTILITIES
GAS
'2
ELECTRIC
WATER SEWAG
PUBLIC SEPTIC
PRIVATE ❑ SEWER ❑
PARCEL NO. i,r,} 3 03U1—
LEGAL DESCRIPTION:
Actual Set Bac s in Feet to:
North.a-'—"1"-'South 5
East Z I West
Size of Parcel Zone Classifica ion
Typenst Occupar
New Const. Valuation
Main Floor
Residential'
Commercial ❑
Spr'nklered
❑Yes ❑No ❑ Reg 'd.
Remodeled Valuation
Upper Floors
Cover Deck
No. Baths
Uncv. Deck
No. Floors
Total Bldg. Floor Area
Greenhouse
Fin. Basement
No. Fin. Rooms
Required Yes❑ No❑
Received Yes❑ No❑
Shorelines/Flood Hazard
Yes NotApplic.la7
Ow
Public ❑nership Privat
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 APPLICATION
OWNER OR AGENT DATE.
SPECIAL APPROVALS
PRELIM. FINAL DATE
Env. Health
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
SPECIAL CONDITION'S: (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 E
Received ❑
FEES COLLECTED
Building
Plumbing
Mech.
Plan Check
SEPA
Modular/
MFG. Home
100
Other (Specify)
TOTAL $ 1 Ct)'—
PERMIT NUMBER
5572
;i7*
* 100,00
* 100006
*000
587,12
06-28-83
z 6179,
LU
J
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATEYS, UED2 8 - 8 3
PERMI47. 2 5 *1 0 Q. 0 0 fo AL
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