1983, 10-28 Permit: 83B-1049 MHPLANNUIR I ,& - At el_ ;A I IUN/FLKMI
�JI SPOKANE COUNTY — DEPARTMENTOF BUILDING & SAFETY
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES -PRESS HARD TO MAKE 3 COPIES
STREET ADDRESS PARCEL NO.
i. , /42/0 0 S 17552-- r
LOT I BLOCK I SUBDIVISION LEGAL DESCRIPTION:
2. -5 1Q5'
OWNER PHONE PHONE
3 LNOSEM 112-2-6i5z
SPECIAL APPROVALS SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
IPRELIM.,FINAL DATE !SN M Ar
Env. Health y: i
Planning
Engineer
Utilities
SEPA
PlansPERMIT IS NONTRANSFERABLE
Exam. PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
BuildJ O IN 180 DAYS
Plan Check
SEPA
Modular/ 00
MFG.
H Home V
Other (Specify)
(7)
TOTAL $
FVRMIT NUMBER
�% ✓�Q4
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATEiS3ui� J _ 3 PERMITI". `- 9 z * 10 U. 0 0 ToolrAL
a -
O
V
W
J_
LL
MAILING ADDRESS
ZIP
Actual Set Backs in Feet to:
` y
/ /
,
North .Z� South l8. r East
West ' Lz
CONTRACTOR
LICENSE EXPIRES
PHONE
Size of ParcelZoneClassification
Residential��
RCommercial
❑
4.
ADDRESS
ZIP
Type Const. Occupancy
Sprinklered
Dyes ❑No ❑Req'd.
DESIGNER
PHONE
New Const. ValuationnQ
Remodeled Valuation
Total Bldg. Floor Area
J.
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.
Flgors
No. Fin. Rooms
No. Dwellings
TYPE NEW ❑ ALT. ❑ AWN. ❑ 13PL. ❑ MVE.
Z,WORK
7•
OF 11 OTHER
�/
ElBLD. ❑ PLMB. ❑ MECH. M.H. ElPOOL
Certifi. of Exempt.
Required
Yes[-] No[-]
Number
or Variance
Received
Yes❑ No❑
DESCRIBEWCQK
Shorelines/ Flood Hazard
Plans Required El
8•
{
MO -.6
Yes Not Applic.❑
Received ❑
VALUATION
SOURCE
OF
GAS J I
ELECTRIC
WATER
PUBLIC ❑
SEWAGE
SEPTIC ❑
Ownership
COLLECTED
9
UTILITIES
PRIVATE ❑
SEWER 1-1
public ❑Private El
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 REQUIRED INSPECTIONS
Plumbing
SIGNATURE OF/ '�j n / APPLICATION
�+ '/L�'� v �� 52 j ��8
OWNER OR AGENT /p`v DATE
Mech.
SPECIAL APPROVALS SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
IPRELIM.,FINAL DATE !SN M Ar
Env. Health y: i
Planning
Engineer
Utilities
SEPA
PlansPERMIT IS NONTRANSFERABLE
Exam. PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
BuildJ O IN 180 DAYS
Plan Check
SEPA
Modular/ 00
MFG.
H Home V
Other (Specify)
(7)
TOTAL $
FVRMIT NUMBER
�% ✓�Q4
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATEiS3ui� J _ 3 PERMITI". `- 9 z * 10 U. 0 0 ToolrAL
a -
O
V
W
J_
LL
"Al