HomeMy WebLinkAbout1983, 10-31 Permit: 83B-1095 MHPLAN NUMBER rI APPLI(CATiON/PERMIT
SPOKANE COUNTY — DEPARIlMENT OF BUILDING & SAFETY
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
Engineer 1 p Other (Specify)
Utilities
TOTAL $-�
SEPA
WHEN MACHINE VALIDAT
Plans PERMIT IS NONTRANSFERABLE THIS BECOMES A PERMIT.
Exam. PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
Buildingj I (� _
3� IN 180 DAYS DATEfSSUEDS 1
Ell
PERMIT NUMBER
53; 5 - i 01515
PERMITL ' 5 C * 5 U' " 0 *fAL
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No. Baths
APPLICANT: COMPLETE NUMBERED SPACES —PRESS HARD TO MAKE 3 COPIES
No. Fin. Rooms
STREET ADDRESS
TYPE eNEW El ALT. ❑ AD'N. 1:1 RPL. El MVE.
PARCEL NO.
7• OF1:1OTHER
Certifi. of Exempt.
LOT
I BLOCK
SUBDIVISION
LEGAL DESCRIPTION:
Received Yes❑ No❑
2.
g
Shorelines/ Flood Hazard
IM � o �kj
S'ny(A LC L-Z'OC 14�14 &G
Yes El Not Applic. ❑
Received ❑
VALUATION
OWNER
GAS
PHONE
PHONE
EPVAGV
SE TIC
Ownership
3.
`Tt"C
i� i s .�;.,� F
a 5
PRIVATE ElSEWER
El
MAILING ADDRESS
ZIP
Actual Set Backs in Feet to:
reverse side, and know the same to be true and correct. All provisions of laws and ordinances governing this type of
C_-7—,ZIC.>S
VILCLAJ<<IC-P_�
ggCi7-7
North South !�
East-3�c> West
Plumbing
CONTRACTOR
Mech.
LICENSE EXPIRES
PHONE
Size of Parcel
Zone ClassificationResidential
PRELIM. FINAL DATE
4.
Plan Check
Env. Health
L�
`1 X L CA
IA
I Commercial ❑
ADDRESS
Planning
ZIP
Type Const.
Occupancy
Spri nklered
Modular/
MFG. Home 60.I Y)
Fire
-N
r_>_ 3
❑Yes El No ❑Req'd.
DESIGNER
PHONE
New Const. Valuation
Remodeled Valuation
Total Bldg. Floor Area
5.
ADDRESS
ZIP
Main Floor
Upper Floors
Garage/Storage
Greenhouse
CHANGE OF USE FROMTO
Cover Deck
Uncv. Deck
Fin. Basement
Unfin. Basement
6.
Engineer 1 p Other (Specify)
Utilities
TOTAL $-�
SEPA
WHEN MACHINE VALIDAT
Plans PERMIT IS NONTRANSFERABLE THIS BECOMES A PERMIT.
Exam. PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
Buildingj I (� _
3� IN 180 DAYS DATEfSSUEDS 1
Ell
PERMIT NUMBER
53; 5 - i 01515
PERMITL ' 5 C * 5 U' " 0 *fAL
a
O
rJ
W
_J
a:
No. Baths
No. Floors
No. Fin. Rooms
No. Dwellings
TYPE eNEW El ALT. ❑ AD'N. 1:1 RPL. El MVE.
7• OF1:1OTHER
Certifi. of Exempt.
Required Yes[-] N
Number
WORK ❑ BLD. ElPLMB. ElMECH. V1 M.H. ❑ POOL
or Variance
Received Yes❑ No❑
DESCRIBE WORK
8•
Shorelines/ Flood Hazard
Plans Required ❑
S'ny(A LC L-Z'OC 14�14 &G
Yes El Not Applic. ❑
Received ❑
VALUATION
SOOFCE
GAS
ELECTRIC
pU6 ICR�
EPVAGV
SE TIC
Ownership
FEES COLLECTED
9• par -)UTILITIES
PRIVATE ElSEWER
El
Public El 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. SEE REVERSE SIDE FOR REQUIRED INSPECTIONS
Plumbing
SIGNATURE OF
S DATECATIO �D
Mech.
OWNER OR GEN
SPECIAL APPROVALS4PPCWL
CONDITIO S: (SEE REVERSE SIDE FOR NOTICE)
PRELIM. FINAL DATE
Plan Check
Env. Health
L�
�r•� ,�
SEPA
Planning
Modular/
MFG. Home 60.I Y)
Fire
Engineer 1 p Other (Specify)
Utilities
TOTAL $-�
SEPA
WHEN MACHINE VALIDAT
Plans PERMIT IS NONTRANSFERABLE THIS BECOMES A PERMIT.
Exam. PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
Buildingj I (� _
3� IN 180 DAYS DATEfSSUEDS 1
Ell
PERMIT NUMBER
53; 5 - i 01515
PERMITL ' 5 C * 5 U' " 0 *fAL
a
O
rJ
W
_J
a:
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