1983, 11-15 Permit: 83B-1653 RemodelPLAN NUMBER
1.
STREET ADDRESS
2.
APPLICATION/PERMIT
SPOKANE COUNTY - DEPARTMENT OF BUILDING & SAFETY
NORTH 811 JEFFERSON / SPOKANE, WrbiblINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
LOT BLOCK 1 SUBDIVISION
i
4.
0,4iU
PARCEL NO.
LEGAL DESCRIPTION:
OWNER )
A
DRESSMAILIAD
17)15 ,f
- /
/. LICENSE EXPIRES
CONTRACTOR
ADDRESS,) t') /./
. 1-707
DESIGNER
PHONE
ZIP
9-&,25-7
Z18 -
Actual Set Backs In Feet to:
North (South
Size of Parcel
last
Type Const. I Occupancy
PHONE
West
Zone Classification I Resident)al 0
Commercial 0
Spr nklered
0Yes ONo OReq'd.
New Const. Valuation Remodeled Valuation Total Bldg. Floor Area
5.
ADDRESS
ZIP
Main Floor 'Upper Floors I Garage I Storage TGreenhouse
CHANGE OF USE FROM
6.
TYPE 0 NEW
7. OF 0 BLD.
WORK
T
Cover Deck lUncv. Deck Fin. Basement lUnfin. Basement
0 ALT. 0 AD' N. -fh RPL. 0 MVE.
KPLMB. 0 MECH. 0 M.H. 0 POOL
0 OTHER
No. Baths
No. Floors No. Fin. Rooms
No. Dwellings
8.
DESCRIBE WORK
VALUATION SOURCE GAS
9. _fl
OF
Number
Certifi. of Exempt. I Required Yes No0
or Variance Received Yes0 Nor
Plans Required 0
Received 0
Shorelines/ Flood Hazard
YesC Not Applic. 0
ELECTRIC 1. WATER SEWAGE
PUBLIC 0 SEPTIC 0
PRIVATE,... SEWER 0
1 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 REVE SE SIDE FOR R RED 1 SP CTIONS
SIGNATURE OF APPLICATION ,
DATE
Ownership
Public 0 Private 0
OWNER OR AGENT
SPECIAL APPROVALS
PRELIM. FINAL DATE
Env. Health
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech,
SPECIAL CONDITIONS: (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)
TOTAL $
PERMIT NUMBER
gee /e6.5
(2
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
' • '
DATE LS1U 1 5
1 6 5.3
PERMIT NO.
TOT
AL
* 1 7, G 0
f
If -$'6`x-0
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