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1983, 10-05 Permit: 83A-9962 MH
IPLANNUM13EM j ArrLI%.;A4 IUN/t LKMI r SPOKANE COUNTY — DER.'-49TMENT OF 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. p�� 1. 5 cr? C) C��S I "155 Z - we* n 251Z-Cp LOT BLOCK S BDIVISION LEGAL DESCRIPTION: 2. 'Z SM U15iA k5r- E— OPHONE PHONE WNER 3. -4 MAILING ACCDRESS ZIP Actual Set Backs in Feet to: ( J — © North South East West CO TRA TOR LICENSE EXPIRES PHONE Size of Parcel 7j� Zone lassif Ion Residential IU/ 4. )( Commercial ❑ ADDRESS ZIP TypeCoi st. , Occ_ Sprinklered Incy U �f Dyes ❑No ❑Req'd. DESIGNER PHONE New Const. Valuation Remodeled Valuation Total Bldg. Floor Area 5. ADDRESS ZIP Main Floor per Floors Garage/Storage Greenhouse CHANGE OF USE FROM TO Cover Deck Uncv. Deck in. Basement Unfin. Ba ement 6. TYPE L7- EW 11 ALT. ❑ AD' N. ❑ RPL MVE. Baths No. Floors ` No. Fin ooms No. DNellings 7. OF ❑OTHER 11 . ❑ PLMB. ❑ MECH. H. ❑POOL WORK Certifi. of Exempt. Required Yes❑ No Number or Variance Received Yes❑ No❑ DESCRIBE WORK 8 Shorelines/ Flood Hazard Plans Required ❑ ( 4 X yes Not Applic. ❑ Received ❑ VALUATION SOOURCE GAS ELECTRIC PIC WATER SEPTIC E Ownership FEES COLLECTED 9• UTILITIES PRIVATE ❑ SEWER ❑ Public ❑ Privatee, 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- Building 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 APPLICATION je/5 OWNER OR AGENT DATE Mach. SPECIAL APPROVALS PRELIM. AL D '11/Env. Health Planning Prevent Engineer Utilities SEPA Plans Exam. Building Tech. SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE) PERMIT IS NONTRANSFERABLE PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED IN 180 DAYS Plan Check SEPA Modular/ Lir. MFG.Home 0 Other (Specify) TOTAL $ a— PERMIT NUMBER WHEN MACHINE VALIDATED IN THIS SPACE, THIS BECOMES A PERMIT. DATE41ui ' 5-815 PERMIT ,. 2 0 * 5 0.0 0 #&AL d O V W J_ LL lU /S"O7 )', Ao' i Moat"