1982, 11-30 Permit: 82B-1455 Special InspectionPLAN NUMBER APPL IICAT ION /PERMIT PERMIT NUMBER
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
STREETADDRESS PARCEL NO.
LOT BLOCK SUBDIVISION
LEGAL DESCRIPTION:
2.
BYQWNER PHONE PHONE
5 928-2592
3.
MAILING ADDRESS
Z
Actual Set Backs in Feet to:
tea— . -7 L7
A'C'0
North South East West
CONTRACTOR
LICENSE EXPIRES
PHONE
Size of Parcel
Zone Classification
Residential ❑
Commercial ❑
4
ADDRESS
ZIP
Type Const.
Occupancy
Sprinklered
❑Yes El No ❑Req'd.
DESIGNER
PHONE
New Const. Valuation
Remodeled Valuation
Total Bldg. Floor Area
5.
ADDRESS
ZIP
Main Floor Upper
Floors
Garage I Storage
Greenhouse
ii
CHANGE OF USE FROM
TO
Cover Deck
Uncv. Deck
Fin. Basement Unfin. Basement
6.
_.
No. Baths No,
Floors
No. Fin. Rooms
No. Dwellings
TOFPE ❑ ElALT. ❑ AD' N. ❑ RPL. ❑ MVE.
/NEW
7. � OTHER
Certifi.ofExampt.
Required Yes[]No❑
Number
WORK BLD. ❑ PLMB. ❑ MECH. ❑ M.H. 13 POOL
or Variance
Received Yes ❑ No ❑
DESCRIBE WORK
Shorelines/ Flood Hazard
Plans Required ❑
8 i i��(�
, ��'`J 1 !!5? 15Ctl
Yes❑ Not Applic. ❑
Received ❑
VALUATI
N
SOURCE
OF
GAS
ELECTRIC
WATERSSE
PUBLIC ❑
EWP IC El
Ownership
FEES COLLECTED
9 UTILITIES PRIVATE ❑ SEWER ❑ Public ❑ Private ❑
1 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 OFA `y APPLICATION
OWNER OR AGEN DATE �l ''�
SPECIAL APPRO ALS PECIAL CONDITIONS: (SEE REVERSES - IDE FOR NOTICE)
PRELIM. FINAL DATE
Env. Health
Planning
Prevent.
SEPA
Pians PERMIT IS NONTRANSFERABLE
Exam. PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
B�'lding ) I IN 180 DAYS
1. 3
Building
Plumbing
Mach.
Plan Check
SEPA
Modular/
MFG. Home
O0
Other (s ity)
S"_�,T'
TOTAL $
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATE , E� 0 — 8 2 PERMIT) 5. 5 z * "' 0 L POtAL
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