1983, 11-07 Permit: 83B-1394 MHPLAN NUMBER APPL ICAT IONVPERMIT ,:
SPOKANE COUNTY — DEPA'�iTMgNT OF BUILDINt SAFETY
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
CHANGE OF USE FROM
TO
APPLICANT: COMPLETE NUMBERED SPACES —PRESS HARD TO MAKE 3 COPIES
eck
STREETADDRESS
Fin. Basement
Unfin. Basement
PARCEL NO.
1.
1E. i Ste
���. N �. o .
-C7,::i(?,;,
2.
LOT
I BLOCK
SUBDIVISION
Floors
LEGAL DESCRIPTION:
No. Dwellings
7-
g
�o we . o •�s-r
OWNER
PHONE
PHONE
3.
'YNA k cAA'w 6 c-
i�E1C f
Ci - 7_311510
❑ POOL
[No.
ofExempt.
MAILING ADDRESS
Yes❑ No
Number
ActualSet Backs in Feet to:
nce
Received
rZIP
North(vS' South' East N-1 s West j-7
8
CONTRACTOR
horelines/Flood Hazard
LICENSE EXPIRES
PHONE
Size of Parcel
Zone Classification
Residential
VALUATION
TA41Z%,F--k
aV ve-5p
ELECTRIC
Ct Z.2-1`�a
`%e>X % "Zg
t Commercial ❑
FEES COLLECTED
ADDRESS
ZIP
Type Const.Occupancy
Sprinklered
C • ��
t!,( � /
�o
��
8—
Dyes ❑No ❑Req'd.
DESIGNER
PHONE
New Const. Valuation
Remodeled Valuation
Total Bldg. Floor Area
5.
ADDRESS
ZIP
Main Floor
Upper Floors
Garage/Storage
Greenhouse
CHANGE OF USE FROM
TO
eck
Uncv. Deck
Fin. Basement
Unfin. Basement
6.
hs No.
Floors
No. Fin. Rooms
No. Dwellings
TYPE NEW ❑ALT. ❑ AD'N. ❑RPL.
❑ MVE.7.
OF
❑ OTHERWORK
❑ BLD. ❑ PLMB. ❑ MECH. VM.H.
❑ POOL
[No.
ofExempt.
Required
Yes❑ No
Number
nce
Received
Yes❑ No❑DESCRIBEWORK
8
�"t�
horelines/Flood Hazard
Plans Required ❑
es❑ NotApplic. ❑
Received ❑
VALUATION
SOURCE
OF
GAS
ELECTRIC
WATER
PUBLIC ❑
SEWAGEship
SEPTIC ❑
FEES COLLECTED
9 UTILITIES PRIVATE ❑ SEWER ❑ Public ❑ Private
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 REV FOR REQUIRED INS C IONS
SIGNATURE OF APPLICATION
OWNER OR AGENT DATE
SPECIAL APPROVALS SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PRELIM. FINAL DATE
Env. Health
Planning
Prevent.
Engineer
Utilities
Plans i i i I PERMIT IS NONTRANSFERABLE
Exam. PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
Tech mg n IN 180 DAYS
Building
Plumbing
Mech.
Plan Check
SEPA
Modular/
MFG. Home i bD . 00
Other (Specify)
PERMIT NUMBER
8313 1,39�
07 *100.00
10 a 0001
A *0,00 00
1 39, 3
1:1 -07-83
6479,
TOTAL $ (00.00
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
n 1
DATE ISSUE O PERMITid11 � 9"� °z' *' 1 .� O° O OfOI'AL
065- oq 02
vL.L l 1 CA
OOV, UD z9 J E--'51