1983, 02-14 Permit: 83A-1084 Fire Damage RepairPLAN NUMBER APPL ICAT ION /PERMIT PERMIT NUMBER
SPOKANE COUNTY — DEPARTMENT OF BUILDING & SAFETY SSA- kc
NORTH 811 JEFFERSON / SPOKANE, WASMNGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES -PRESS HARD TO MAKE 3 COPIES
STREET ADDRESS PARCEL NO.
1. -:5 . V,. s-r, •N - -S k — C3 1
LOT I
BLOCK
I SUBDIVISION
LEGAL DESCRIPTION:
2. 12-
a1
SASX\-M60 (�s
OWNER
PHONE
PHONE
3.
MAILING ADDRESS
ZIP
Actual Set Backs in Feet to:
Qq
North I South East West
CONTRACTOR
LICENSE EXPIRES
PHONE
Size of Parcel Zone
Classification
Residential
4. :'t5�; ..t\ O ry c
'rj '(r 4 i4
Commercial ❑
ADDRESS
N, S-I0S r-,\A K T
ZIP
P zDi
Type t.
Occu
Z
Sprinklered
❑Yee ONo ❑Req'd.
DESIGNER
PHONE
New Const. Valuation
FAtilmodeled Valuation
12"*id
Total Bldg. Floor Area
5.
Ooa
-- _
ADDRESS
ZIP
Main€loo' Upper
Floors Garage/Storage
Greenhouse
CHANGE OF USE FROM
TO
Cover Deck
Uncv. Deck
Fin. Basement
Unfin. Basement
6.
-
TYPE ❑JNEW 13 ALT. 11 AWN. ®'RPL. 11MVE.
No. Baths No.
Floors
No. Fin. RoomsNo.
Dwellings
7. ❑OTHER
_
Certifi of Exempt
Required Yes❑ No
Number
WORK BLD. 11PLMB. ❑ MECH. ❑ M.H. ❑ POOL
or Variance
Received Yes❑ Nov
SCRIBE WORK
8.
Shorelines/ Flood Hazard
Plana Required ❑ )
Ei�ii1(Z FkQr— �i�w. C;.
Yes Not Applic. ❑
Received ❑ w( A-
VALUATION
I SOURCE
GAS
ELECTRIC
WATER
PUBLIC ❑
r S
SEPT
TI
Ownership
F
FEES COLLECTED
I
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
G(O•CX�
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
of construction. SEE REVERSE SIDE FOR REWIRED INSPECTIONS
Plumbing
SIGNAYURE OF APPLICATION
OWNER OR AGENT ���— 2�
DATE
Mech.
SPECIAL APPROVALS
SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PRELIM. FINAL
DATE
Plan Check
Env. Health
SEPA
Planning
Modular/
MFG. Home
>_
Fire
Prevent.
d
Other (Specify)
O
V
Engineer
W
TOTAL $�
J
LL
Utilities
SEPA
PERMIT IS NONTRANSFERABLE
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
Plans
Exam.
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
7 _
DATEQSSUElj 4 R — "�9. 8• `k z * 9 6. O O 0 --j
PERM 1
Building
Tech.
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