1983, 03-07 Permit: 83A-1554 AdditionPLAN NUMBER
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.
2.
STREET ADDRESS
l(03 N ZZIC`*A
PARCEL NO. 2-5 SSS — 3 j -2--
LOT LOT
BLOCK
tZ 3
3
OWNER
SUBDIVISION
r—t c cmc E.& -t -AT€ S
PHONE
cl`at3
St—,Atm 6LA4$
MAILING ADDRESS
E iu 3i`7•
CONTRACTOR
4. D:e7, Cr—tAA—
ADDRESS
DESIGNER
5.
LICENSE EXPIRES
PHONE
ZIP
crit 3 -7
PHONE
LEGAL DESCRIPTION:
Actual Set Backs in Feet to:
North E 15 1u u.t
Size of Parr/1
(Z 7 / 12 e -EZ(...)
j(
ZIP
03�7
Type Const.
Occupancy
ZZe Classification
Residential ❑
Commercial ❑
Sprinklered
❑Yes ❑No Req 'd.
PHONE
New Const. Valuation
�z
Remode
ed Valuation
Total Bldg. Floor Area
ADDRESS
ZIP
6.
CHANGE OF USE FROM
TYPE
7. OF
WORK 2.1-1:
TO
❑ ALT. WAD' N. ❑ RPL. ❑ MVE.
❑ PLMB. ❑ MECH. ❑ M.H. ❑ POOL
Main Floor
Cover Deck
Upper Floors
Garage/Storage
Greenhouse
Uncv. Deck
Fin. Basement
Unfin. Basement
❑ OTHER
No. Baths
No. Floors
No. Fin. Rooms
No. Dwellings
Certifi. of Exempt.
or Variance
Required Yes❑ Nor/
Received Yes No
Number
8.
DESCRIBE WORK
t .
9.
le; E.1—( . -
SOURCE
F
UTILITIES
VALUATION
Ex a t✓X(rpoKit I—Disv2v5 ...
GAS ELECTRIC WAPUBLIC ❑ SER EPTIC ❑
PRIVATE ❑ SEWER
Shorelines/Flood Hazard
Yes Not Applic.VV
Plans Required ❑
Received ❑
Ownership
Public ❑ Private
I hereby certify that 1 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.
work will be complied with whether specified he
thority to violate or cancel e pr•l ision- •f any
of construction. SEE REV . SI E F • R REQ
SIGNATURE OF
OWNER OR AGENT
n or
er
All provisions of laws and ordinances governing this type of
no
ta
The granting of a permit does not presume to give au-
r local law regulating construction or the performance
CTIONS
APPLICATION 3a(TTL E
DATE
SPECIAL APPROVALS SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PRELIM. FINAL DATE
Env. Health
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
0(94
741
�1r�1L.t. Qi1 p..A. s t cs* e Y v...'ri
. Jy
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)
TOTAL $
PERMIT NUMBER
6-5/3(-t
Cj
r.
•
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATE tsstlED0 7 _.0 3'
PERMIT It J 5.4 5
*47,001V"L
‘11
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