1983, 08-09 Permit: 83A-7501 GaragerLANNUIVIcstn /�1rrLl�i11 IVrltl/ rCnlrlI l
SPOKANE COUNTY - DEPART!11ENT OF BUILDING & SAFETY
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
CHANGE OF USE FROM
6.
TO
No. Baths No. Floors No. Fin. Rooms I No. Dwellings
TOFPEW ❑ ❑ALT. AD'N. ❑RPL. ElMVE.
7. ❑ OTHER
WORK BLD. E]PLMB. ❑ MECH. ❑ M.H. El POOL
Certifi.ofExempt.
APPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 3 COPIES
1
STREETrDDRESS
or Variance
Received Yes❑ No❑
PARCEL NO. �
r
Shorelines/ Flood Hazard
NI I �
8• fiC77 }< 2O
Yes El Not Applic. ❑
Received ❑
VALUATION
LOT
BLOCKsuBDIVISIO
ELECT AC
WATER
PUBLIC
SEWAGE/
SEPTIC ftT
Ownershlp
LEGAL DESCRIPTION:
2.
9.
OF
I UTILITIES
{ 14�
PRIVATE ❑
SEWER ❑
public ❑Private
ONNNER
P ON
PHONE
3.
Building
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
MAIL
G ADDRESS
OSIGNATURE
AGENT LLQ DATE
Mach.
ZIP
Actual Set Backs InFeetto:
North South East West
CONTRACT
R
LICENSE EXPIRES
PHONE
Size -off Parcelone
X I � ij
�
Classification
�P I G
]
Residential
Commercial ❑
4.
/ e
ADDRESS
ZIP
Type
t.
Occu
Sprin ed
v
Incy
❑Yes o ❑Req'd.
DESIGNER
PHONE
New Const. Valuation
Remodeled Valuation
Total Bldg. Floor Area
5.
ADDRESS
ZIP
Main Floor
Upper Floors
GaragelStorage
Greenhouse
CHANGE OF USE FROM
6.
TO
No. Baths No. Floors No. Fin. Rooms I No. Dwellings
TOFPEW ❑ ❑ALT. AD'N. ❑RPL. ElMVE.
7. ❑ OTHER
WORK BLD. E]PLMB. ❑ MECH. ❑ M.H. El POOL
Certifi.ofExempt.
Required Yes❑ No❑
Number
or Variance
Received Yes❑ No❑
DESCRIBEORK
Shorelines/ Flood Hazard
Plans Required
8• fiC77 }< 2O
Yes El Not Applic. ❑
Received ❑
VALUATION
SOURCE
GAS
ELECT AC
WATER
PUBLIC
SEWAGE/
SEPTIC ftT
Ownershlp
FEES COLLECTED
9.
OF
I 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
Building
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
Plumbing
OFR i [i / �`2
APPLIOWNER X
�J,�Z
OSIGNATURE
AGENT LLQ DATE
Mach.
SPECIAL APPROVALS SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PFaE IM. FINAL DATE �1 4
Env. Health } / , iy. :.� l ro. n i�
+ . �js f LFOf� I
Planning tj
Fire
Prevent. r r
Engineer
Utilities
- /i
Iu :( '`•`�` �SL[ Gz22c' V I
SEPA VIF Z13 -9 Z xpp"/"'""
Plans PERMIT IS NONTRANSFERABLE
Exam. PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
Tech mg IN 180 DAYS
Plan Check
SEPA
Modular/
MFG.Home
Other (Specify) r�
TOTAL $ /
rCnrvn i I'lUIV cn I
b� � 1
WHEN MACHINE VALIDATED IN THIS SPACI
THIS
oBECOMES A PERMIT. 77
DATE ISSUEDO 9 gPERMITMO O- 193
*4 7,o o 0
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FT
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