1983, 09-13 Permit: 83A-8999 MHrLANPfUI IOrN 1 IUN/F LKMI i PERMIT NUMBER
_ ,,_SPOKANE COUNTY — DEPAR,rm8NT 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
�. lv -` C _ �.NO.
LOT
BLOCK SUBDIVISION
LEGAL DESCRIPTION:
2.
l W1t ✓� \c�cN "' �S`T \5 � �►pc>,T�o r.i
_ ._
_
OWNER
PHONE
PHONE
:�—
MAILING ADDRESS
ZIPua
Set Backs in Feet to:
O C i Yy�r. Q
a 2l
North t South \St East West -jam
CONTRACTOR
LICENSE EXPIRES
PHONE
Size of Parcel Zone
Classification
Residential
4. ",M
'79)c '45 I
R OA H
Commercial o
ADDRESS
ZIP
Type Const.
Occupancy
Sprinklered
❑Yes ❑No ❑Req'd.
DESIGNER
PHONE
New Const. Valuation
Remodeled Valuation
Bldg. Floor Area
V,—:S
TTotal
5.
0: � L'
ADDRESS
ZIP
Main Floor Upper
Floors Garage/Storage
Greenhouse
CHANGE OF USE FROM
TO
Cover Deck
Uncv. Deck
Fin. Basement
Unf in. Basement
s.
TYPE
No. Baths No.
Floors
No. Fin. Rooms
No. Dwellings
NEW ❑ALT. ❑ AD' N. ❑//RPL. ❑ MVE.
7 ❑OTHER
CertifI.ofExempt.
-7Received
Required Yes❑ No❑
Number
WORK ❑ BLD. ❑ PLMB. ❑ MECH. 00 M.H. ❑ POOL
or Variance
Yes❑ No❑
DESCRIBE WORK
8.
ShorelineslFlood Hazard
Plans Required ❑
� u3L C Uj 1 0 in
Yes[] Not Applic. ❑
Received ❑
VALUATION
I SOURCE
OF
GAS ELECTRIC
WATER
PUBLIC t/
SEWAG
SEPTIC
Ownership
FEES COLLECTED
9' —7,S �
UTILITIES
PRIVATE ❑
SEWER ❑
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-
Building
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
Plumbing
SIGNATURE OF APPLICATION -71
OWNER OR AGENTS DATEIlk _
Mach.
SPECIAL APPROVALS SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PRELIM. FINAL DATE
Env. Health
Planning %
Fire
Prevent.
Engineer
Utilities CLQ
Plans PERMIT IS NONTRANSFERABLE
Exam. PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
Building k_ ,-L IN 180 DAYS
Plan Check
SEPA
Modular/
MFG. Home G.
Other (Specify)
TOTAL $ ��O'�
WHEN MACHINE VALIDATED
THIS BECOMES A PERMIT.
DATE ULI of 3- 8 3PERMIT NO o * 10 O O 0 TOTAL
CIL
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V
W
J_
U.
ISS
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