1983, 05-31 Permit: 83A-4617 RemodelPLAN NUMBER APPL R;A I ION /-PERM
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 PARCEL NO.
LOT BLOCK SUBDIVISION LEGAL DESCRIPTION:
2.
O NER PHONE PHONE
I\?S� S3' S`1
3' rNP�LIN ADDRESS ZIP Actual Set Backs in Feetto-
!5 1
o:51 U 199zo
North West
CONTRACTOR LICENSE EXPIRES PHONE Size of Parcel Zone Cl ifica_ tion Residential ❑
SAIMIM
S1, C��w� ;�) Commercial El4. ADDRESS ZIP TypekConst. Occupancy Dyes �❑Norte ❑Req'd.
DESIGNER PHONE New Const. Valuation Remodeled Valuation Total Bldg. Floor Area
Utilities
Plans3� PERMIT IS NONTRANSFERABLE
Exam. PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
Building n t _ IN 180 DAYS
TOTAL $
WHEN MACHINE VALIDATED IN TH
THIS BECOMES A PERMIT.
PERMIT NUMBER
63
5'
ADDRESS
ZIP
Main Floor Upper
FloorsGarage/Storage
Greenhouse
CHANGE OF USE FROM
TO
Cover Deck
Uncv. Deck
Fin. Basement
Unfin. Basem(
6.
,_-_
No. Baths No.
Floors
No. Fin. Rooms No. Dwellings
TYPE❑NEW El AD'N. ❑RPL. E3 MVE.
7. ❑OTHER
C :empt.
Required Yes❑ No Num
, ,"'.
WORK � �E)PLMB. ❑ MECH. ❑ M.H. ❑ POOL
or Variance
Received Yea ❑ No ❑
�
DESCRIBE WORK �(jyL#!
Shorelines/ Flood Hazard
Plans Required EV
8• ��
Yes❑ Not Appl .
Received
VALUATION
SOURCE
OF
GAS
ELEC RIC
WATER
PUBLIC ❑
SEWAGE
SEPTIC ❑
Ownership
FEES COLLECTED
9
UTILITIES
PRIVATE ❑
SEWER ❑
public ❑Private
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
Building
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
Plumbing
SIGNATURE OF APPLICATION
OWNER OR AGENT DATE
Mach.
SPECIAL APPROVALS
SPECIAL CONDITI NS: (SEE REVERSE SIDE FOR NOTICE)
Plan Check
PRELIM. FINAL DATE
Env. Health
SEPA
Planning
Modular/
MFG. Home
Fire
Prevent.
Other (Specify)
G,,,,;,,
I
I
Utilities
Plans3� PERMIT IS NONTRANSFERABLE
Exam. PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
Building n t _ IN 180 DAYS
TOTAL $
WHEN MACHINE VALIDATED IN TH
THIS BECOMES A PERMIT.
PERMIT NUMBER
63
6 o
DATE IT5D_ 31 — PERMIT NA. �' * 0 O NOTAL
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6 o
DATE IT5D_ 31 — PERMIT NA. �' * 0 O NOTAL
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