1983, 06-15 Permit: 83A-5309 ResidencePLAN NUMBER
€33 1(
APPLICATION/PERMIT
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 DDRESS
,. TIiffyco
2. A
'T' LA46
PARCEL NO. 02.1541 — 21�
BLOCK
OWNER
3 MTOOJNi&1
10,o
MAILI_ ADDRESS (j LAWIC-
SUBDIVISION
t -r 7S - 07_-.00
PONE
--2703
LEGAL DESCRIPTION:
PHONE
CON4L��/t
4.
ADDRESS,:
t
DESIGNER
5. ADDRESS
LICENSE EXPIRES
CPC 2
HONE
Actual Set Backs In Feet to:
North
2S 1
South (East 1Z I West CO
ZIP
Size of Parcela Classification
lo`e 1zreticc-.
Spr'nklered
❑Yes ❑No ❑Req'd.
Type Cops
New \V/NNN aluation I /
PHONE
I pan ,A
3� I
Remodeled Valuation
Residential -E. -
Commercial 0
Total Bldg. Floor Area
ZIP
CHANGE OF USE FROM
6.
TO
1°117 Coar
Upper Floors
Garage/Storage
CO -ti
Greenhouse
Uncv. Deck
Fin. Basement
Unfiq. Boer
TYPE yW 0 ALT. 0 AD' N. 0 RPL. ❑ MVE.
!
WORK BLD. ❑ PLMB. 0 MECH. 0 M.H. 0 POOL
0 OTHER
No. t
v
No Floors
No. Fin. Rooms
No lianas
Certifi. of Exempt.
or Variance
8.
DES
VALUATION
9.
+R nt/ G�y 6,
SOURCE GAS ELECTRIC WATER
F IC
UTILITIES PRIVATE 0
Shorelines/Flood Hazard
Yes: Not Applic.❑
❑ No❑ Number
Plans Require4,E3
Received
Required Yes
Received Yes No❑
SEWAGEJ
SEPTIC
SEWER 0
Ownership
Public 0 Privetg�
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-
thority to violate or cancel the provisions of any other state or local law regulating construction or the performance
of construction. SEE REERSE SIDE FOR REOUIRED INSPECTIONS
SIGNATURE OF
OWNER OR AGENT
SPECIAL APPROVALS
PRELIM. FINAL DATE
'tk&-r 162
Env. Health
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Mars
Exam.
Building
Tech.
b4
E16
APPLICATION 5_ ay
DATE
SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
„.22,r
5
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 $ -=—�
PERMIT NUMBER
P.)A - 53°)
02* *34200
*342006
A *000 S
53Q8g
0'6-15-83
6479.
F
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATEJSSUtDy' 5 ='84.3.
PERMIT -y(3: O 9'Z * 3'4'2 0.0n"`
4
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