1983, 04-14 Permit: 83A-2934 AdditionPLAN NUMBER
APPLICATIONIPERMIT
SPOKANE COUNTY — DEPARTMItNT'OF BUILDING & SAFETY
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
1.
2.
STREET ADDRESS
N170e7
LOT BLOCK
bocci -<
PARCEL NO.
o(/ X43 - oq-A-
SUBDIVISION
071;Onit r(". C5' 30E2
ONE 34Q
OWN_ VV Loci I(
3. MAILING Iiot L/-�cW-
Q. ADDRESS
PHONE
LEGAL DEIIOrSUNy p, b 1= S
5-131 38'FfoFN262 ,76rtCr- W �Z
LICENSE EXPIRES
H6NE?_oe
Actual Set Backs in Feet to.
North ISouth"]�2_11
East
Swot PaNNrcel h//, _ /ss %Classifi tion
:...A_1 Types � SM n
klered
❑Yes ONo OReq•d.
Total Bldg Floor Area
ZIP
DESIGNER
5.
ADDRESS
PHONE
1 West 4-6
Residential IV
-
Commercial 0
New Const. Valuation
927
Remodeled Valuation
ZIP
Main tour V//^^
Upper Floors
Garage/Storage
Greenhouse
6.
CHANGE OF USE FROM
TO
Cover Deck
Uncv. Deck
Fin. Basement
Unfin. Basement
TYPE 0 W 0 ALT. ,„Et D'N. 0 RPL. 0 MVE.
WORK7. OF
LD. 0 PLMB. 0 MECH. 0 M.H. 0 POOL ❑OTHER
No Baths
No. Floors
No. Fin. Rooms
No. Dxellings
Certifi. of Exempt.
or Variance
Required Yes0 No0
Received Ves0 No0
DESCRIBE
( 2 I JCC r 1100\ Y
VALU TION 1 SODURCE GAS ELECTRIC
9• I OF
UTILITIES
Shorelines/Flood Haze d
Vies Not Appllc. 0
Plans Req i
Number
Re12*7d
8.
Received 0
WATER
PUBLIC
PRIVATE 0
SEWAGE
SEPTIC HT
SEWER 0
Ownership
Public 0 Private 13
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 FO REQUIRED INS CTIONS
SIGNATURE OF - - APPLICATION
OWNER OR AGENT DATE
SPECIAL APPROVA
PRELIM. FINA DATE
Env. Health
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
7f2-
SPECIAL
fZ
SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PERMIT IS NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
FEES COLLECTED
Budding
Plumbing
Mech.
Plan Check
SEPA
Modular/
MFG. Horne
Other (Specify)
TOTAL $ 963
PERMIT NUMBER
ferM-
*9600
*96008
A • *0.00
293.32
04'-14-83
2 6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
�pp7 ,4/II'V �,//II 2' a '
DATE ISSUED1' 41 _ 8 3, PERMIT NO 95.4 -z *9 6.010 TOTAL
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