1983, 07-05 Permit: 83A-6104 BoilerPLAN NUMBER APPLICATION/PERMIT
SPOKANE COUNTY - DEPARTMENT OF BUILDING & SAFETY
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
L
APPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 3 COPIES
STREETADDRESS
Floors
Garage/Storage
PARCEL NO.
1
8 o v
w G U -L-
Lor
BLOCK
SUBDIVISION
CHANGE OF USE FROM
LEGAL DESCRIPTION:
2.
Uncv. Deck
Fin. Basement
Unfin. Basemf
6.
O
ER
PHONE
PHONE
3.
Tt1�
No. Baths No.
Floors
Z - O'l `!
No. Dwellings
MAILING ADDRESS
ZIP
Actual Set Backs in Feet to:
N J\e$04
ENV`
—
North South East West
CO TRACTOR
.
LICENSE EXPIRES
PHONE
Size of Parcel
Zone Classification
Residential El
`
T)
$A ^ 4'U1
Shorelines/ Flood Hazard
Plans Required ❑
Commercial ❑
4.
m0 C_l�
Received ❑
VALUATION
SOOUFCE
GA
ELECTRIC
ADDRESS
j
ZIP
-M
Type Const.
Occupancy
Sprinklered
Dyes ❑No ❑Req'd.
,t'•L73 .i.L1^j___
28
SEWER ❑
Public ❑ Private ❑
DESIGNER
1 hereby certify that I have read and examined this application and have read the "NOTICE"
provisions included on
PHONE
New Const. Valuation
Remodeled Valuation 7
Total Bldg. Floor Area
5.
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 REVERUSIDE F.0RjF(EjiaED INSPECTIONS
Plumbing
ADDRESS
ZIP
Main Floor Upper
Floors
Garage/Storage
Greenhouse
CHANGE OF USE FROM
TO
Cover Deck
Uncv. Deck
Fin. Basement
Unfin. Basemf
6.
No. Baths No.
Floors
No. Fin. Rooms
No. Dwellings
TYPE =NEW' ❑ ALT. ❑ AD'N. El RPL. 11MVE.
7. ❑OTHER
WORK ❑ BLD. ❑ PLMB. B'fVIECH. ❑ M.H. El POOL
Cartifi.ofExempt.
Required
Yes❑ No❑
Number
or Variance
Received
Yes ❑ No ❑
DESCRIBE WORK
8'
Shorelines/ Flood Hazard
Plans Required ❑
'
d"A 81
1
tor- 00 L_ �1 \
Yes❑ Not Applic. ❑
Received ❑
VALUATION
SOOUFCE
GA
ELECTRIC
-WATPUB ICO
R]
Sr=WAGE
SEPTIC ❑
Ownership
FEES COLLECTED
9•
UTILITIES
PRIVATE ❑
SEWER ❑
Public ❑ Private ❑
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 provisions of any other state or local law regulating construction or the performance
of construction. SEE REVERUSIDE F.0RjF(EjiaED INSPECTIONS
Plumbing
SIGNATURE OF APPLICATIO
OWNER OR AGENT DATE
Mach. ""—
SPECIAL APPROVALS
SPECIAL (TIONS: (SEE REVERSE SIDE FOR NO ICE)
PRELIM. FINAL DATE
Plan Check
Env. Health
t �\VW7 �.O O
SEPA
Planningp
f ? _ SO
f
T� a
e'�If _ 1
Modular/ GulHome
Fire
Prev-nt.
Engineer
M •5 o
Other (Specify)
Utilities
TOTAL $
SEPA
WHEN MACHINE VALIDATI
Plans
PERMIT IS NONTRANSFERABLE
THIS BECOMES A PERMIT.
Exam.
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
Building IN 180 DAYS
Tech.
n�
DATE AZEi D O 5— 8 5
PERMIT NUMBER
8!aA Colby
PERMITND` O'4 z * 19. O OfO#-AL
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