1983, 08-12 Permit: 83A-7747 MHIrLAN NUMtbtN
ArFLI,A 1 ION/I'LKMIT
SPOKANE COUNTY - DEPARTII1IENT OF BUILDING & SAFETY .
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 3 COPIES
STgEET A)7DRESS
1.
2.
LOT
7
BLACK
3.
4.
OWNER
4U4
14017 r-0
PARCEL NO. 175 r�
SUBDIVISION
►�� iv►.I 51
, 1gtigiE
" 7050
PHONE
LEGAL DESCRIPTION:
MA ING. DRE_ SS
CWCI-( y
�J6
el
LICENSE EXPIRES
Z� D27
PHONE
Actual Set Backs in Feet to:
North 1-7 'south
East 3
West
Sizecel
7x
Zone Class attipn
Residential �l
Commercialll ❑
ADDRESS
ZIP
Type ilt.
Spr'nklered
❑Yes ❑No ❑Req'd.
DESIGNER
5.
ADDRESS
PHONE
New Const. Valuation
Remode ed Valuation
Total Bldg. Floor Area
ZIP
Main Floor
Upper Floors
Garage/Storage
Greenhouse
6.
CHANGE OF USE FROM
TYPE .0 NEW
7. OF
WORK 0 BLD.
TO
Cover Deck
Uncv. Deck
Fin. Basement
Unfin. Basement
❑ ALT. ❑ AD' N. ❑ RPL.
❑ PLMB. 0 MECH. M.H.
❑ MVE.
❑ POOL ❑ OTHER
No. Baths
No. Floors
No. Fin. Rooms
No. Dwellings
Certif1. of Exempt.
or Variance
Required Yes No❑
Received Yes No
Number
8. DESC{iIBE WOR
9.ON
IVCOUi II
of3l L,. 1
SOURCE
UTILITIES
GAS
lOC %0
ELECTRIC
Shorelines/Flood Hazard
Yes❑ Not Applic. ❑
Plans Requ'red ❑
Received ❑
WATER,, -
PRIVATE ❑
SEWAGE/
SEPTIC
SEWER ❑
Ownership
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-
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 REQUI EINSPECT,OJIS
SIGNATURE OF<, �: ' _�' / APPLICATION
OWNER OR AGENT
DATE
SPECIAL APPROVALS SECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PRELIM. FINAL DATE
Env. Health
8-13
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
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 $
PE MIT NUMBER
')"7L1" -7
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATEUEDI 2 - 8' 3
PERMIT"NO. " 7
*50.00TAL
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0
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0
6
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A/o•oL'yG"O
•
40
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/7'
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