1983, 04-21 Permit: 83A-3162 ResidencePLAN NUMBER APPLICATION/PERMIT
SPOKANE COUNTY - DEPMTMENT OF BUILDING & SAFETY
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES —PRESS HARD TO MAKE 3 COPIES
STREET ADDRESS PARCEL NO.
1. Ai , II G (zA O 7�L �'c+v 6t' V552."% - iiT�
LOT BLOCK SUBDIVISION LEGAL DESCRIPTION:
2. i2-rb
1 -%
M P t:VC _-!! k S -c
WNER
PHONE
PHONE
wv..s_ k- h.w�
GL- Q- - er__5_ G
3.
MAILING ADDRESS
ZIP
Actual Set Backs in Feet to:
ti k0rA N . I Q y.\i2 0
aa!�r
North 5' South East
�West
CONTRACTOR
LICENSE EXPIRES
PHONE
Size of Parcel
Zone Classification
Residential
cSr7t Y1G
�c i �.D
A.G f2.r
Commercial ❑
4.
ADDRESS
Type Const.
y
Sprinklered
�c
�"oZIP
�3 _I
❑Yes ❑No ❑Req'd.
DESIGNER
PHONE
ew Const. Valuation
Remodeled Val&,ation
Total Bldg. Floor Area
1
1104111
5.
ADDRESS
ZIP
Main Floor
per Floors
Garage/Storage
Greenhouse
CHANGE OF USE FROM
TO
Cover Deck
Uncv. Deck
Fin. Basement
Unfin.-Somment
s.
..�
TYPE / ❑ RPL. ❑ MVE.
TY 'oJ
No. Bat
No. Floors
No. Fire. Rooms
a
No. Dwellings
NEW ❑ ALT. ❑ AD'N.
7
/ ❑OTHER
H BLD. ❑ PLMB. ❑ MECH. ❑ M.H. ❑ POOL
Certifi.ofExempt.
Required
Yes❑ No
Number
WORK
orVarianoe
Received
YesO No❑
DESCRIBEWORK
Shorelines/ Flood Hazard
Plans Required
8.
S i NC,Lt? ?rAMt4_Lt—t;Z=%, i p NCS
Yes❑ Not Applic. ❑
Received
VALUATION
SOURCE
GAS
ELECTRIC
I WATER
PUBLIC
SEWAGE
SEPTIC
Ownership
i
FEES COLLECTED
9.
OF
I UTILITIES
PRIVATE ❑
SEWER O
Public ❑ Private W4
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
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 Bions of any other tate or local law regulating construction or the performance
of construction. SEE REVE SI E FO REQUIR INSPECTIONS
Plumbing
SIGNATURE OFAPPLICAT'W'
MAI RIFRn0 Ar_GNT � FiPiV7/ _. DATE D/
Mach.
SPECIAL APPROVALS I SPECIAL CONDIT S: (SEE REVERSE SIDE FOR NOTICE)
Env. Health
��L1J
Planning
Fire
Prevent.
Engineer
i
Utilities
SEPA
� Plans PERMIT IS NONTRANSFERABLE
Exam. e p PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
Building _ IN 180 DAYS
Plan Check
SEPA
Modular/
MFG. Home
Other (Specify)
PERMIT NUMBER
TOTAL $_�� I
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
q --21-g3 316.20 *222.00°
DATE UED PERMIT NO. TOTAL
D
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0
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,
14�
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