1983, 05-25 Permit: 83A-4489 MH11V""U�^ Mr'rLIL+/y 1 IV IV/ r,C.nIrll 1 Vr-MMIl NUMbl=H
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
STREET ADDRESS PARCEL NO.
�. N. it ier
LOT I
BLOCK
SUBDIVISION
LEGAL DESCRIPTION:
2 - SA (O I
i'6
C orte1,N +on. 'ra 6tawsroo4a%36
OWNER
3 _De' Ct iN C YL IUY
PHONE
PHONE
AILING ADDRESS
Actual Set Backs in Feet to:
,�,�,�
ZZ R •� 'F2G 1?. o. vz-wK 2.44 � - 0444)
rZIIP/5..�''
`"1C�-
+
North South 4 East !>9 4; ' west
CONTRACTOR
LICENSE EXPIRES
PHONE
Size of Parcel
Zone Classif ication
Residential V11f
4.
1i3X 114:5
1 A( -.%(?-k
Commercial ❑
ADDRESS
ZIP
Ty nst. Occupancy
Sprinklered
15A
?J
'R --'s
Dyes ❑No ❑Req'd.
DESIGNER
PHONE
Const. Valuation
Remodeled Valuation
Total Bldg. Floor Area
5.
ADDRESS
-
ZIP
Main Floor Upper
Floors
Garage/Storage
Greenhouse
CHANGE OF USE FROM
Cover Deck
Uncv. Deck
Fin. Basement
Unf in. Basement
6.
TO—
PE
No. Baths No.
Floors
No. Fin. Rooms
No. Dwellings
NEW ❑ALT. 1:1 AD'N. El FPL. El MVE. ❑ OTHER
!• OF
Certifi. of Exempt.
Required Yes❑ Nog'Number
WORK ❑ BLD. ❑ PLMB. ❑ MECH. M.H. ❑ POOL
or Variance
Received Yes❑ No❑
DESCRIBE WORK
8•
Shorelines/ Flood Hazard
Plans Required ❑
5 1 W. Ob^ IM . 4. It �} ZQ
Yes❑ Not Applic. ❑
Received ❑
VALUATION I SOURCE
OF
GAS
ELECTRIC
WATE
PUBLIC
SEWAGE
SEPTIC
Ownership
FEES COLLECTED
UTILITIES
PRIVATED
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-
Building
thority to violate or cancel the provisions of any other state or local law regulating construction or the performance
of construction. SE SE SIDE FOR REQUIRED INSPECTIONS
Plumbing
SIGNATURE OF APPLICATIQN �D
�1 Q
OWNER OR AGEN DATE
Mach.
SPECIAL
APPROVALS
SPE IAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PRELIM. FINAL DAT
Plan Check
Env. Health
f
SEPA
Planning
Modular/ ��,
MFG. Home
>,
Fire
Prevent.
Other (Specify)
a
O
v
Engineer
T -A
W
J
W
Utilities
TOTAL $
SEPA
PERMIT IS NONTRANSFERABLE
WHEN MACHINE VALIDATED IN
THIS BECOMES A PERMIT.
THIS SPACE,
Plans
Exam
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
(({{ p
DATE4S UE� 5 - 8 PERM149.
//�� //��
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Building
Tech.
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