1983, 04-01 Permit: 83A-2509 DamperPLAN NUMBER
APPLICATION/PERMIT
SPOKANE COUNTY — BUILDING CODES DEPARTMENT
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 3•COPIES
JOB ADDRESS
1.
LOT
2.
/ B o a a w k
BLOC UBDI VISION
LEGAL DESCRIPTION - SEE ATTACHED "
PARCE;aNUMBER/S
OWNER
3. Class . C eren 3) 4 -
ADDRESS
PHONE
9dy-iy9zl
ZIP
9.9 c')i
Actual Set Backs in Feet
North 'South
East
(West
4.
5.
CONTRACTOR
m
A�Q
ADDRESS
is
DESIGNER
PHONE
PHONE
Size of Parcel
Type Const.
Valuation
Occupancy
Zone Classification
Sprinklered
❑Yes DNo 0 Req'd.
Building Area In Sq. Ft.
ADDRESS
ZIP
Main Floor
Upper Floors Garage Area
Storage
CHANGE OF USE FROM
6.
TO
Area of Decks
Finished Basement
Unfin. Basement
TYPE
OF
WORK
0 NEW D ALT.
0 BLO. D PLMB.
❑ AD N. 0 RPL. 0 MVE.
IEMECH. 0 M.H. 0 POOL
0 OTHER
No. Baths
No. Stories
No. Rooms
No. of Dwellings
CERTIFICATE
of EXEMPTION
Req'd.
Recd.
Not Req'd.
DESCRIBE WORK
8. SO -u& 1'kat,
Enum. Dist. I Location (Area)
VALUATION SOURCE
OF
9. UTILITIES
GA
ELECTRIC
WATER
SEWER
Ownership
Public ❑ Private 0
USE CODE
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 authority 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 jj((jj \yyL'""II
SIGNATURE OF APPLICANTikdidet ✓„'If
DATE OF APPLICATION
3- a9-$3
SPECIAL APPROVALS
NAME DATE
Env. Health
arming
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
SPECIAL CONDITIONS:
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check '
SEPA
Mobile Home
Other (Specify)
,64)0
TOTAL
PERMIT NUMBER
A 1507
04* *14.00
*14.006.,
*000
250,82
04-01-83
2 6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
04i�1,0 J 7.�81i3'
DATEISSUEDI
2'51'0.9 Z
PERMITNO.
*114. (HrgiAL