1983, 09-13 Permit: 83A-9000 MHPLANNUMBERI APPLICATION/PERMIT
SPOKANE COUNTY - DEPAR rME14T OF BUILDING & SAFETY '
s.. NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES —PRESS HARD TO MAKE 3 COPIES
STREETADDRESS PARCEL NO.
1. fly . 1 u7✓%•�
Lor I BLOCK I SUBDIVISION LEGAL DESCRIPTION:
2. Cv Z ` Ait>szcr."
OWNER PHONE PHONE
3.
E 0 ir, M cj C C'.�
q:2. - .
MAILING ADDRESS
ZIP
Actual Set Backs in Feet to:
O •
a40.;L-7
North South L�v� East 5d5 I West
CONTRACTOR
LICENSE EXPIRES
PHONE
Size of Parcel Zone
Classification
Residential
4.
_15A V -C
S k 1 50
R N!N I
Commercial ❑
ADDRESS
ZIP
Type Const. Occupancy
Sprinklered
:5 P^%
❑Yes ❑No ❑Req'd.
DESIGNER
PHONE
NeConst. Valuation
Remodeled Valuation
Total Bldg. Floor Area
5.
i
ADDRESS
ZIP
Main Floor Upper
Floors Garage/Storage
Greenhouse
CHANGE OF USE FROM
TO
Cover Deck
Uncv. Deck
Fin. Basement
Unfin. Basement
6.
No. Baths No.
Floors
No. Fin. Rooms
No. Dwellings
TYPE NEW ❑ALT. ❑ AD' N. ❑RPL.
❑ MVE.
7•
OF
❑OTHER
WORK ❑ BLD. ❑ PLMB. ❑ MECH. 'C M.H.
❑ POOL
Certifi. of Exempt.
Required Yes❑ NojV
Number
or Variance
Received Yes❑ No❑
""--
8.
DESCRIBE WORK
jj
Shorelines/ Flood Hazard
Plans Required ❑
� t,.0C �l
res❑ Not Applic. ❑
Received ❑
9
ALUATION
SOURCE
GAS
ELECTRIC
PUBLIC
SEPT CW
Ownership
/
FEES COLLECTED
�S
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 provisions of any other state or local law regulating construction or the performance
I
of construction. SEE REVERSE SIDE FOR REQUIRED INSPECTIONS
SIGNATURE OF APPLICATI N
V
Plumbing
OWNER OR AGENT
DATE ;/�
Mach.
SPECIAL APPROVALS
PRELIM. FINAL DATE
Env. Health
Planning
Prevent.
Engineer -1/ter
Utilities
SEPA
Plans
Exam.
Building
Tech. �r
SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
I
PERMIT IS NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
Plan Check
SEPA
Modular/
MFG. Home J` �•C
Other (Specify)
TOTAL $ t5o'm
PERMIT NUMBER
_ o dxO
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT. ((}}
DATEMUECl 3 - 3 PERMITQ O�. 0. 0 z
%'fAL
d
O
C-1)
W
J
LL
- ti-
AJ CAO ft^"ee= l-1 129. 144,
R