1983, 02-24 Permit: 83A-1307 Garager'LAIN ArrL 1(l.A I IVN / rLKM i
SPOKANE COUNTY — DEPARTMENT OF BUILDING & SAFETY
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
PERMIT NUMBER
3
CHANGE OF USE FROM
TO
APPLICANT: COMPLETE NUMBERED SPACES —
PRESS HARD TO MAKE 3 COPIES
Fin. Basement Unfin. Basement
STREET ADDRESS
s.
PARCEL NO.
1
N. 5Ci7 1� S
TYPE �j ❑ALT. ❑ AD' N. ❑RPL. ❑ MVE.
1 ?S'55 -a
X54`7
LOT
BLOCK
SUBDIVISION
! OF �EW
❑ OTHER
LEGAL DESCRIPTION:
OWNER PHONE
PHONE
3.
L �.a
Lia.=��
Certifi. of Exempt.
Required Yes❑ NoO
Number
MAILINGADDRESS
Received Yes ❑ N. V
ZIP
ua t n Feet to:
DESCRIBE WORK$' �+ %
Shorelines/Flood Hazard
' `
�+ .(�� 1"t%i4►45
f��
North South Co
East West
CONTRACTOR
GAS
LICENSE EXPIRES
PHONE
Size of Parcel
Ownership
/FEES
Zone Classification
Residential
4
UTILLIITIES
PRIVA E ❑
CoS ►
Public ❑ Private
T2,M`,
Commercial ❑
ADDRESS
reverse side, and know the same to be true and correct. All provisions of laws and ordinances governing this type of
ZIP
Type Const.
Occupancy
t
Sprinklered
thority to violate or cancel the provisions of any other state or local law regulating construction or the performance
of construction. SEE REVERSE SIDE FOR ELEQUIRED INSPECTIONS
Plumbing
y,
SIGNATURE OF APPLICATION
Dyes ❑No ❑Req'd.
DESIGNER
Mech.
PHONE
Coi. Valuation
Remodeled Valuation
Total Bldg. Floor Area
5.
PRELIM. FINAL
DATE
cir,
Plan Check
zaADDRESS
ZIP
Main
Upper Floors
SEPA
Modular/
Garage/Storage
Greenhouse
MFG. Home
Y
Fire
PERMIT NUMBER
3
CHANGE OF USE FROM
TO
Cover Deck
Uncv. Deck
Fin. Basement Unfin. Basement
s.
TYPE �j ❑ALT. ❑ AD' N. ❑RPL. ❑ MVE.
No. Baths No.
Floors
No. Fin. Rooms
No. Dwellings
! OF �EW
❑ OTHER
I
WORK BLD. ❑ PLMB. ❑ MECH. ❑ M.H. ❑ POOL
Certifi. of Exempt.
Required Yes❑ NoO
Number
or Variance
Received Yes ❑ N. V
DESCRIBE WORK$' �+ %
Shorelines/Flood Hazard
Plans Required ❑
`%ArK
yes Not Applic. ❑
Received ❑
VALUATION SOURCE
9.
GAS
ELECTRIC
WATERS
BLIC
EWA0 1 SE TICG�fi/
Ownership
/FEES
COLLECTED
UTILLIITIES
PRIVA E ❑
SEWER 11
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
Building
work will be complied with whether specified herein or not. The granting of a permit does not presume to give au-
t
thority to violate or cancel the provisions of any other state or local law regulating construction or the performance
of construction. SEE REVERSE SIDE FOR ELEQUIRED INSPECTIONS
Plumbing
SIGNATURE OF APPLICATION
OWNER OR AGENT DATE
Mech.
SPECIAL
APPROVALS
SP CIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PRELIM. FINAL
DATE
Plan Check
Env. ealth
ZT
SEPA
Modular/
Planning
MFG. Home
Y
Fire
Prevent.
a
Other (Specify)
a
V
Engineer
W
J_
Utilities
TOTAL $
SEPA
IS NONTRANSFERABLE
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
PlansPERMIT
Exam.
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
((�� 77 11 7 j�
4� - 8 3 0. z * 4 7' O
Building
Tech.
DATIAS9UE� PERMITN�. / " 0OITAL