1983, 05-13 Permit: 83A-4019 ACPLAN NUMBER
APPLICATION/PERMIT
SPOKANE COUNTY — DEPARTMENT OF BUILDING & SAFETY
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
STREET ADDRESS
LOT
2.
BLOCK
SUBDIVISION
OWNER
3 /1f G)/Z,
PHONE
P ONE
�'3 7
PARCEL NO.
LEGAL DESCRIPTION:
MAILING ADDRESS
LI" ,e5OX //a. /1 ier9- /�
C NTRACTOR
4. 0,414/.6‹ Pe!1A,A/Iite
ADD SS
Cl ,Bei /71-544
'10
�yz //
Actual Set Backs in Feet to:
North [South (East I West
LICENSE EXPIRES
—74/-7
PHO E
�5=/7/✓
Size of Parcel 1 Zone Classification
Residential ❑
Commercial ❑
Type Const.
Occupancy
Sprinklered
❑Yes ❑No ❑Req'd.
5.
DESIGNER
PHONE
New Const. Valuation
Remodeled Valuation
Total Bldg. FioorArea
ADDRESS
ZIP
Main Floor
Upper Floors
Garage/Storage
Greenhouse
6.
CHANGE OF USE FROM
TO
Cover Deck
Uncv. Deck
Fin. Basement
Unfin. Basement
TYPE ❑ NEW
7. OF
WORK 0 BLD.
0 ALT. IAD' N. ❑ RPL. 0 MVE.
0 PLMB.'MECH. ❑ M.H. 0 POOL
0 OTHER
No. Baths
No. Floors
No. Fin. Rooms
No. Dwellings
Certifi. of Exempt.
or Variance
Required Yes❑ No❑
Received Yes No
Number
DESCRIBE WORK
8. `i►/T.�,��.- ,9/>C Gein/V/r/Zi/
Shorelines/Flood Hazard
Yes ❑ Not Applic. 0
Plans Required ❑
Received 0
VALUATION
9.
SOURCE
F
UTILITIES
GAS
ELECTRIC
WATER
PUBLIC 0
PRIVATE ❑
SEWAGE
SEPTIC 0
SEWER 0
Ownership
Public 0 Private 0
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
SIGNATURE OF
OWNER OR AGENT
SPECIAL APPROVALS
PRELIM. FINAL DATE
Env. Flealth
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
APPLICATION
DATE
SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
it//14e2 .,.2,A-
%
PERMIT IS NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
FEES COLLECTED
Building
Plumbing
Mech.
Plan Check
SEPA
Modular/
MFG. Home
Other (Specify)
TOTAL $ /7 ��
PERMIT NUMBER
-40(
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATE
SSUED' 3 - U i
QQ, O
1
PERMIT M O. , Z
*1400, ,fi,L