1983, 10-25 Permit: 83B-836 DuplexPLAN NUMBER
APPLICATION/PERMIT
SPOKANE COUNTY - DEPARTF4ENT OF BUILDING & SAFETY
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
STREET ADDRESS
PARCEL NO.
.541
LOT
2.
BLOCK SUBDIVISION
OWNER
3Rc..1-E !�-:�P A--:
MAILING ADDRESS
CONTRACTOR
4
ADDRESS
/a tl4
PHONE
LICENSE EXPIRES
DESIGNER
5.
ADDRESS
CHANGE OF USE FROM
6.
PHONE
ZIP
PHONE
ZIP
PHONE
ZIP
TO
TYPE ANEW ❑ ALT. ❑ AD' N. ❑ RPL. ❑ MVE.
7 OF WORK (BLD. ❑ PLMB. ElMECH. ❑ M.H. ❑ POOL ❑ OTHER
LEGAL DESCRIPTION:
Actual Set Backs in Feet to:
North Zc) South
Size of Parcel
i (Z ac&, t. m_bik (L
Type Const. Occupancy
East — I West /
Residential Q
Commercial ❑
Zone Classification
Sprinklered
❑Yes ❑No Req 'd.
New Const. Valuation Remodeled Valuation
SCO—
Total
Total Bldg. Floor Area
Main Floor !Upper Floors I Garage/Storage
Cover Deck
Uncv. Deck
Fin. Basement
Greenhouse
Unfin. Basement
No. Baths
No. Floors
No. Fin. Rooms
No. Dwellings
Certifi. of Exempt.
or Variance
Required Yes❑ No
Received Yes
No ❑
Number
DESCRIBE WORK
VALUATION
9.
SOURCE
UTILLIITI ES
GAS
ELECTRIC
Shorelines/ Flood Hazard
Yes El Not Applic.
WATER
PUBLIC
PRIVATE ❑
SEWAGE
SEPTIC C9
SEWER ❑
Ownership
Public ❑ Private
hereby certify that I have read and ,xamined 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 whe ° er specified herein or not. . ranting of a permit does not presume to give au-
thority to violate or cancel th- .rovisions of any other a .cal law regulating construction or the performance
of construction. SEE REVE E SIDE FAR REQUIR -%I, SP TIONS
or
e
SIGNATURE OF
OWNER OR AGENT
DATE APPLICATION
SPECIAL APPROVALS
PRELIM. FINAL DATE
Env. Health
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
2O
SPEC) L C• DITIONS: (SEE REVERSE SIDE FOR NOTICE)
PERMIT IS NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
Plans Required C7/
Received it
FEES COLLECTED
Building
Plumbing
Mech.
Plan Check
SEPA
Modular/
MFG. Home
Other (Specify)
TOTAL $ 4)-4_co
PERMIT NUMBER
835
2* *424.00
*42400
A *000 8
66.1 g
10-20-83
6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATEIS3UED2 5 _ 8 3
PERMIT Ns. 3, 6 5 * 4 2 4 0 0 ZiAL
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