1983, 08-26 Permit: 83A-8273 MHIPLANNUMt5hH I ArrL1%.#A i 1UN/ rtK1Y1I i
SPOKANE COUNTY - DEPARTIMENT OF BUILDING & SAFETY
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
STRE ADDRESS PARCEL N0. ��
i . , + �' (�
2 LOT BLOCK su Dlvlslor� , LEGAL DESCRIPTION:
I��T
OVt(NER PHON
MAIL N ADDRE I
Ilk
Z
Actual Set Backs in Feet to: ,
15 I� U
North South J East West
CO COB
LICENSE EXPIRES
1-101NEZ9of
I Zone
Cl if'cation
Residentia
4
Commercial ❑
ADDRESS
ZIP
Type Ocqupancy
Sprinklered
�J
❑Yes ❑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 FROM
TO
Cover Deck
Uncv. Deck
Fin. Basement
Unfin. Basement
s.
No. Baths No.
Floors
No. Fin. Rooms
No. Dwellings
TYPE NEW ❑ ALT. ❑ AD'N. ❑ RPL. ❑ MVE.
7 WORK 13 BLD. E3PLMB. 11MECH. 01M.H. El POOL ❑OTHER
Certifi.ofExempt.
Required Yes❑ No El
Number
•
or Variance
Received Yes❑ N
8 DE; AR BE�i RK
Shorelines/ Hazard
Plans Required 11'
otA
Yes❑ NotAppl' : ❑
Received ❑
VALU 'FI N
1 ���
SOUR E GAS
OF
ELECTRIC
WATER
PUBLIC
SEWAGE
SEPTIC
Ownership
FEES COLLECTED
9 { U
UTILITIES
PRIVATE ❑
SEWER ❑
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 provi 'ons of any p1her state or local law regulating construction or the performance
of construction. SEE I RE6011ED INSPECTIONS
Plumbing
SIGNA REO APPLICATION 9,5
OWNE ORA ENT DATE s�
Mach.
SPECT
SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PRELIM. FINAL DATE
Plan Check
Env. Health
,�//
-*
SEPA
Modular/
J50
Planning
FG.Home
Engineer
Utilities
Plans I I I I PERMIT IS NONTRANSFERABLE
Exam. PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
Building IN 180 DAYS
Tech.
Other (Specify)
TOTAL $
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT. Q
DATE4s9UEf� 6 J PERMIA2. 7' 3 z
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