1983, 08-24 Permit: 83A-8120 PipingPLAN NUMBER
APPLICATION/PERMIT
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.
2.
STREET ADDRESS
CG �% / 5- MA /A/
LOT
BLOCK
SUBDIVISION
3. OWNER- Cc/ fin c2epAercL
MAILING ADDRESS
PHONE
PHONE
PARCEL NO.1
/7sy3—LW
LEGAL DESCRIPTION:
ZIP
4.
5.
6.
CONTRACTO,'
[/Sora / z eel SO,
LICENSE EXPIRES
t -W'7/
PHONE
S - S=7333
Actual Set Backs in Feet ter
North 'South [East West
Size of Parcel
Zone Classification
Residential 0
Commercial 0
ADDRESS
E• 4Q3 //,SS,or-
ZIP
0/9aar
Type Const.
Occupancy
Spr nklered
DYes ONo DReq'd.
DESIGNER
PHONE
New Const. Valuation
Remodeled Valuation
Total Bldg. Floor Area
ADDRESS
ZIP
Main Floor
Upper Floors
Garage/Storage
Greenhouse
CHANGE OF USE FROM
TO
Cover Deck
Uncv. Deck
Fin. Basement
Unfin. Basement
TYPE 0 NEW
7: OF
WORK 0 BLD.
%c,LT. 0 AD' N. 0 RPL. 0 MVE.
❑ PLMB. 0 MECH. 0 M.H. 0 POOL
❑ OTHER
No. Baths
No. Floors
No. Fin. Rooms
No. Dwellings
Certif1. of Exempt.
or Variance
Required VesD No0
Received YesD No
Number
8.
DESCRIBE WORK
Shorelines/Flood Hazard
Ves° Not Aeolic. 0
Plans Requ red D
Received 0
VALUATION
9.
SOURCE
F
UTILLIITIES
GAS
ELECTRIC
WATER
PUBLIC 0
PRIVATE D
SEWAGE
SEPTIC 0
SEWER 0
Ownership
Public 0 Private 0
I hereby certify that I have read and examined this appl cation 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 OF �
OWNER OR AGENT. /)
APPLICATION czr_�3_ I/
DATE t7 eJ
SPECIAL APPROVALS SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PRELIM FINAL DATE
Env. Health
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
otri-
/ i 1 35
PERMIT IS NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
FEES COLLECTED
Building
Plumbing
Mech.
Plan Check
SEPA
Modular/
MFG Home
Other (Specify)
TOTAL $ /goo
PERMIT NUMBER
83+' -Size
®4 1.988-rn00619
E4 6479.
WHEN
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
f�,p �
DAYE'4S5t1E�.4 - 8 3
PERMI1U.ZOZ *1aO04001JrAL