1983, 04-04 Permit: 83A-2552 MHPLAN 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
1.14,3514
2.
STREET ADDRESS
LOT
BLOCK
3.
RfANO
SUBDIVISIO
SP O k .Ac019
Tx/% M'cod tz-r
MAILING ADDRESS
CO !{CT,rO ,
PHONE
_ — 3
PHONE
PARCEL NO. 040 ^ �
LEGAL DESCRIPTION: 76 Or A
LICENSE EXPIRES
PHONE
ADDRESS
DESIGNER
5.
ADDRESS
ZIP
PHONE
Actual SetcBacks in Feet to:
North rJ 'South (East I West '53- 67
Sizegf5arcel % 14' iipngClassifi tjone Residential
75�? rJ�qj Commercial ❑
4.•
Type
New Const. Valuation
Spr'nklered
❑Yes 0 N Req 'd.
Remode ed Valuation
Total Bldg. Floor Area
ZIP
Main Floor
Upper Floors
Garage/Storage
Greenhouse
6.
CHANGE OF USE FROM
TO
Cover Deck
Uncv. Deck
Fin. Basement
Unfin. Basement
TYPE EW 0 ALT. 0 AD' N. 0 RPL. ❑ MVE.
7 OF ❑ OTHER
WORK 0 BLD. ❑ PLMB. ❑ MECH. 2M.
H. 0 POOL
No. Baths
No. Floors
Certifi. of Exempt.
or Variance
No. Fin. Roomsj
Required Yes�a / no❑
Received Ye No❑
No. Dwellings
Number
8.
DpiOL7112K 1.4a11.4a10.2
�
VALUATION SOURCE \ GAS ELECT/RIC
9 - 000UTILLIITIES
Shorelines/Flood Hazard
Yes ❑ Not Applic. ❑
Plans Required ❑
Received ❑
WATER
PUBLIC
PRIVATE ❑
SEWAG
SEPTIC
SEWER 0
Ownership
Public ❑ Privatq
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 REVERSE SIDE FOR REQUIRED INSPECTIONS
SIGNATURE OF
OWNER OR AGENT
3
O --Lt r
SPECIAL APPROVALS SPECIAL CONDITIONS: (ft
PRELIM. FINAL DATE
Env. Health
Planning
Fre
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
�23
APPLICATION 3— 2.3 , g
DATE
VERSE 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 $
K7
10040
PERMIT NUMBER
07 * 1 00.0'0
*100,006
A *0.00 0
255:1•@
p4_04-83
.2 6479..
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATEQ U
PERMI12N,2 5 *10 0. 0 0 tdTAL
ItMIT No.
Spokane County
Planning Department
ShQrt Plat
Exemption Certificate
'a5 9-K
go17-4Aoofrrav
1. WAS THIS PARCEL SEGREGATED BEFORE MARCH 13. 1978, OR WAS APPLICATION
TO SEGREGATE MADE BEFORE,:MARCH 13, 1978 ?
(exempt under section 3.365 of Short Plat Ordinance)
2. IS THIS PARCEL 10 ACRES IN SIZE OR LARGER ?
(exempt under section 3.3E of Short Plat Ordinance)
3. WILL THIS PARCEL BE USED FOR A PUBLIC'UTILITY FACILITY ?
(exempt under section 3.364 of Short Plat Ordinance)
7,4. IS THIS SEGREGATION BEING ACCOMPLISHED TO EFFECT A MINOR BOUNDARY
OR PROPERTY LINE ADJUSTMENT, BUT NOT CREATING ANY NEW LOTS OR
V CAUSING OTHER LOTS TO FALL BELOW MINIMUM ZONING STANDARDS FOR SIZE
SHAPE OR FRONTAGE, OR AFFECTING ROAD ACCESS TO ANY OTHER LOTS ?
(exempt under section 3.3H of Short Plat Ordinance)
5. IS THIS PARCEL ZONED RESIDENTIAL OFFICE. LOCAL BUSINESS, COMMERCIAL,
FREEWAY COMMERCIAL, INDUSTRIAL OR MANUFACTURING ?
(exempt under section 3.354 of Short Plat Ordinance)
APPROVED BY:
NO
-YES 1010
YES
YES
YES
DATE: ‘3 /17 /33
I hereby certify t,• answers I have offered in connection with obtaining
this exemption are true..........
APPLICANT'S SIGNATURE:. i�"/ pC7�wc� DATE:
'lAn•l .v. . l t NI Ht Nu.l lIINL.
N /21 Itt'{tHSOH S'HEE1
SPOKANt 'WASHINGTON 99160 PNONt 4Sh;2105
75'
qzit's 1
0
I
3
0 I
3
0
3
GAL
0
as'
118
3 gJrni
e.
(FLrr (AO
.4
t-L-roN RD .
147'
i°i112C. EL L'..0‘ 5- it3-3 111
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