1983, 07-08 Permit: 83A-6329 Pre Fab ResidencePLAN NUMBER I APPLICATION/PERMIT
IL 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
1. STREESADDRESS PARCEL NO.
L TNN ��BL990C/2K I SUBDI tsloNLEGAL DESCRIPTION:
2. Z U Ti✓ rl�t�r
MAIL NG ADORES
ZIP
Actual Set Backs in Feet to:
� `7 South
North East
West
CON CTOR
LICENSE EXPIRES
PHONE
X26 — �✓
Size of Parcel
10 x 1 tiY
neCl ification
Residenti
Commercial ❑
4.
ADDR SS
ZIPType
Co st Occupa
y
Sprinklered
2
(
❑ ❑ d
Yes No ❑R
DESIGNER
PHONE
New Cqnst. Valuati n
Remodeled ValuationTotal
Bldg. Floor Area
5.
ADDRESS
ZIP
Main Floor Upper Floors
Gara a/St ora a
Greenhouse
CHANGE OF USE FROM
Cover Deck
Uncv. Deck
Fin. Basement
Unfin. Basement
TO——
6.
TYPE
No. Baths No.
Floors
ton. Rooms
No. Dwellings
!• OF /NEW ❑ALT. ❑ AD' N. ❑RPL. ❑ MVE. ❑OTHER
WORK P7BLD. ❑ PLMB. ❑ MECH. ❑ M.H. ❑ POOL
Certifi. of Exempt.
Required
Yes❑ No❑
Number
or Variance
Received
Yes❑ No[]
D RI W pQ
��
Shorelines/ Flood Hazard
Plans Required El8.
C�
Yes❑ Not Applic. Pf,
Received ❑
VALUATION
SOURCE
GAS ELECTRIC
WATER
SEWAG
Ownership
FEES COLLECTED
inn
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 ca the provisions of any other state or local regulating construction or a performance
of construction. SEE EV SI FOR REQUIRED INSPECTI S
Plumbing
SIGNATURE OF APPLICATION
OWNER OR AGENT DATE
l
Mech.
SPECIAL APPROVALS
PRELIM. FINAL D
Env. Health
Planning
Engineer
Utilities
SPECIAL CONDITIONS: (SEE RE%ERSE SIDE FOR NOTICE)
ri e -14'r LA Ce- ( i�0 - fi t 2 C)
Pians PERMIT IS NONTRANSFERABLE
Exam. PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
Building 7
Tech. IN 180 DAYS
.�
Plan Check
SEPA
Modular/ ��
MFG. Home
Other (Specify)
TOTAL $ –+—
WHEN MACHINE VALIDATED IN TH
THIS BECOMES A PERMIT.
PERMIT NUMBER
PACE,
YO8-8�3 6329z *16100°�
DATE ED PERMIT NO. TOTAL
IL
O
v
W
J
LL
Z� z