1983, 10-05 Permit: 83A-9935 MH1Ar
F'LAIV Ivunntst1-1 I SPOKANE COUNTY L DEPARTIMENT OF UILDING & SAFETY I rtl9,5AuM�935
�1 NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 98260 / (509) 456-3675
5.
ADDRESS
CHANGE OF USE FROM
6. ,
TO
ZIP
TYPE 6'NEW ❑ ALT. ❑ AD' N. ❑ R ❑ MVE.
7 OF El OTHER
WORK ❑ BLD. ElPLMB. 13MECH. H. 13POOL
Q
N ITzI ❑Yes ❑No ❑Req'd
New Const. Valuation Remodeled Valuation
L-1/
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
,rte
,.
STREET ADDRESS
Main Floor
Upper Floors
Garage/Storage
PARCEL NO.
9" pp
UTILITIES
I
Cover Deck
Uncv. Deck
Fin. Basement
Unfin. Basem
Z
I hereby certify that I have read and examined this application and have read the "NOTICE" provisions included on
LOT
SUBDIVISION
No. Floors
No. Fin. Rooms
LEGAL DESCRIPTION:
thority to violate or cancel the provisions of any other state or local law regulating construction or the performance
2.
LABLOCK
Certifi. of Exempt.Required
—t
Yes❑ No
Number
or Variance
SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
Received Yes❑ No❑
O NERPHONE
Shorelines/ Flood Hazard
PHONE
3.
NvL
Planning
Z —
ZZZ
MAILING ADDRE S
p
Actua, Set Backs in Feet to:
MFG. Home S� —
Fire
Prevent.
North 10 South I I
East C) West
(p Q
CONTRAC OR
LICENSE EXPIRES
PHONE
�
Size of Parcel
Zone Classi ication
Residential
1 1
f5
Z-7
8 Y 136-
Commercial ❑
4.
-
5.
ADDRESS
CHANGE OF USE FROM
6. ,
TO
ZIP
TYPE 6'NEW ❑ ALT. ❑ AD' N. ❑ R ❑ MVE.
7 OF El OTHER
WORK ❑ BLD. ElPLMB. 13MECH. H. 13POOL
Q
N ITzI ❑Yes ❑No ❑Req'd
New Const. Valuation Remodeled Valuation
Total Bldg. Floor Area
Received ❑
,rte
SOURCE
g q O
Main Floor
Upper Floors
Garage/Storage
Greenhouse
63 Lt
9" pp
UTILITIES
I
Cover Deck
Uncv. Deck
Fin. Basement
Unfin. Basem
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
No. Baths
No. Floors
No. Fin. Rooms
No. Dwellings
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 REOUIRED INSPECTIONS
Plumbing
Certifi. of Exempt.Required
—t
Yes❑ No
Number
or Variance
SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
Received Yes❑ No❑
Shorelines/ Flood Hazard
Plans Required ❑
�, ,. • 1 ^ t 4 X Co A
8.1 kl
Yes ❑ Not Applic. ❑
Received ❑
VALUATIbN
SOURCE
GAS
ELECTRIC WAOF PUBE ❑
SEPTIC SEWAGE,
Ownership
FEES COLLECTED
9" pp
UTILITIES
I
PRIVATE El
SEWER
Public ❑ Private 2(1
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
Building
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 REOUIRED INSPECTIONS
Plumbing
SIGNATURE OF APPLICATION P
DATE �� P
Mach.
OWNER OR AGENT
SPECIAL APPROVALS
SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PRELIM. FINAL DATE
Plan Check
Env. Health
SEPA
Planning
Modular) +"
MFG. Home S� —
Fire
Prevent.
�
Other (Specify)
4ISnoinear
1
1 1
— j
Utilities
PlansPERMIT IS NONTRANSFERABLE
Exam. PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
Building IN 180 DAYS
TOTAL $ J
WHEN MACHINE VALIDAT
THIS BECOMES A PERMIT.
DATE �S Z 5
995,56Z *50.00°
PERMIT NO. TOTAL
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