1983, 10-20 Permit: 83B-641 ResidencePLAN NUMBER
1.
APPLICAT;OIj/PERMIT
SPOKANE COUNTY — DEPARTMENT OF BUILDING & SAFETY
NORTH 811 JEFFERSON / SPOICANE,'IASHINGTON 99260 / (509) 456.3875
APPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 3 COPIES
STREET ADDRESS
� . 13,I 1? AVS
PARCEL NO.
03511- -41-03
LOT BLOCK SUBDIVISION
2. -2)j �s i- E- O VC
OWNER
3. CI1i N t LqN N4 cc.JsV
MgLLING ADDRESS fp.
old io_'I-'
CONTRp.�yTOqu
4. ��11 _AA11
ADDRESS
•
DESIGNER
5. ADDRESS
PI g.5 pro
PHONE
LEGAL DESCRIPTION:
LICENSE EXPIRES
PHONE
Actual Set Backs In Feet to:
North 30 (South
ZIP
PHONE
Size of ParcelOC I zi
�/ Occu3 y I' Spr nklered
% I u ❑Yes ❑No ❑Req'd.
New Coalgati n Remodeled Valuation Total Bldg. Floor Area
East I.- I West 1S
Residential 8"
Commercial 0
ZClassiftca n
TypeTic]
ZIP
nFl r
Upper Floors
Ga age/S
Gree
6.
CHANGE OF USE FROM
TYPE 2("CI
7. OF D.
WORK
TO
❑ ALT. 0 AD' N. 0 RPL. ❑ MVE.
❑ PLMB. 0 MECH. 0 M.W. 0 POOL
0 OTHER
Cover Deck
No. Vs
Uncvv.�eck, Io.
No. Flooyq
Fin Basement
No. Fi_n. Rooms
No. Drillings
Certifi. of Exempt.
or Variance
Required Yes ❑ No❑
Received Yes No❑
Number
8. DESC IBEWORK� eNI�7 /�av1/4"te2
WATER
PUBLIC
PRIVAT 0
9.
VALUATION
SOURCE
OF
UTILITIES
GAS
ELECTRIC
Shorelines/Flood Haze d
Ves❑ Not Applic.❑
Plans Requ red f�j
Received �/
SEWAGE/
SEP!
SEWER ❑
Ownership
Public 0 Private
I hereby certify that I have read and examined this appl cation 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 (fled here or not. The granting of a permit does not presume to give au-
thority to violate or cancel the ro Ions of an ,} her state or local law regulating construction or the performance
of construction. SEE REVE E FOR d'J RED SP6!`TIONS
SIGNATURE OF
OWNER OR AGENT
SPECIAL APPROVALS
PRELIM. FINAL DATE
Env. Health
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
�rWL
to-av
APPLICATION
DATE
PECIAL CONDITIONS: (SEE REVERSE 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 $ G
PERMIT NUMBER
G111
02*
02* *36600
*366008
A *000 8
6&02
10-20-83
2 6479
0.
0
O
V
W
J
LL
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATE'JSSUEd-' D '' 041•
PERMIT NI. 6 *'3 616.0 0 dtAL
N.
1
4.
'
C2:
r
54'
5z
--
-42
D t LP (2, LY
rTh
t--t-OE:7;,:ril (.4 ,:••17••"•r::••
• - • ,
co
LO