1983, 08-12 Permit: 83A-7710 ResidenceLEGAL DESCRIPTION:
PLAN 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
STREET ADDRESS
1.
LO BLOCK
2.
P-tJ-
SUB�DIr 3 - 05,
3. °Prrot\l 73115-69,c
MAILING ADDRESS
HONE
ZIP
4• CQNT AN TO�i,,.frO � LICENSE EXPIRES
A-416 p�1
ALQDRESS KIP
PARCEL NO.
2C7 4i v 1 C(riToJ
Actual SetLBacks in Feet to:
North `T 'South
Size of Parcel
x X4"7!
[East l r I West
Z ne IassificatiDn
Type V 1"
NII
DESIGNER New onst. Va uation
5. ADDRESS
CHANGE OF USE FROM
6.
TYPEW
7. OF
BLD.
WORK
PHONE
ZIP
TO
❑ ALT. E AD' N. ❑ RPL. ❑ MVE.
❑ PLMB. ❑ MECH. ❑ M.H. ❑ POOL
❑ OTHER
Mall Floor
Residential,
Commercial ❑
Spr'nklered
❑Yes ❑No Req 'd.
emodeled Valuation
Upper Floors
r--
Garage/Storage
f
Cover Deck
Unc
DESGR1B 0I �� I `
8. R=1\L£6y
VALUATION
9.
SOURCE
UTILITIES
►J/60, e
GA
ELECTRIC
WATER
PUBLIC
PRIVATE ❑
SEWAGE
SEPTIC
SEWER ❑
No. Baths
No. Floors
Certif1. of Exempt.
or Variance
Total Bldg. Floor Area
Greenhouse
Fin. Basement
No. Fin
ms
Required Yes ❑ No
Received Yes No ID
Shorelines/Flood Hazard
Yes ❑ Not Applic. ❑
Ownership
Public ❑ Private B'
I hereby certify that I have read and examined this application and have read the "NOTICE" provisions included on
reverse ?Ide, 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
DATE CATION a 5 , 8
SPECIAL APPRO ' LS
PRELIM. FINAL DATE
Env. Health
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
ex7goy
ECIAL 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. Dyvellings
Plans Required i://
Received C
FEES COLLECTED
Building
Plumbing
Mech.
Plan Check
SEPA
Modular/
MFG. Home
Other (Specify)
TOTAL $
PE= MIT NUMBER
02*
* 29600
* 296006
*0.00 0
770,9-g
08-12-83
6479.
0
V
W
J
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
n R i� l R '7,, L
DATE ISSUED` PERMITrNO. 1. O z * 2 9 6. O -O t�OIrAL
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