1983, 12-27 Permit: 83B-2792 ResidencePLANNUMBERI APPLIGA 1 ION/PERMIT
SPOKANE COUNTY - DEPARTMENT OF BUILDING & SAFETY
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
5.
ADDRESS
ZIP
APPLICANT: COMPLETE NUMBERED SPACES -
PRESS HARD TO MAKE 3 COPIES
,.
STREETADDRESS
1 SEWER
Cover DOCK
U a
PARCEL NO.
1.3
6.
idtk
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
-- i 10-21
Plumbing
SIGNATURE OF APPLICATION
OWNER OR AGENT DATE Z—
Mach.
SPECIAL APPR V S
2
LOT
Bt�OCK
SUBDIVI l9N ,�
LEGAL DESCRIPTION:
El AWN. E] RPL.
11 MVE.
Planning
C
7•
OW E� I
�� �'
PHONE ,
PHONE
3..J
3
N -vl'�
WORKLD. ❑ PLMB. ❑ MECH. ❑ M. H.
W
El POOL
Certifi. df Exempt.
MAILING AD RESS
rfR
Yes❑ No 1-1
ZIP
Actual Set Backs in Feet to:
v
15— 14—
or Variance
North I () South +
East West
4.
CONTRAQTO
A
v
LICENSE EXPIRES
PHONE
Size of
-?.5
.
Shorelines/ Flood Hazard
�eCltion
V c
Residential
Commercial ❑
0
ADDRESS
A
ZIP
Type rponot.
upan y
Receive
Sprinklered
VALUATION
I SOURCE
OF
GAS
EL CTRICWATER
PUBLIC
`
Dyes❑No ❑Req'd.
DESIGNER
PHONE
New Const. Valuation
I rl
Remodeled Valuation
Total Bldq. Floor area
5.
ADDRESS
ZIP
9
CHANGE OF USE FROM
TO
PRIVATE ❑
1 SEWER
Cover DOCK
U a
Fin. Basement
Uniin. Basent
6.
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 REWEIRSE SIDE FOR R UI INSPECTIONS
Plumbing
SIGNATURE OF APPLICATION
OWNER OR AGENT DATE Z—
Mach.
SPECIAL APPR V S
SPECIAL CONDITI N . (SEE REVERSE SIDE FOR NOTIC )
FI DATE
No. Bat No.
FI rs
No. Fj� Acorns
No. Dwellings
TYPE El ALT.
El AWN. E] RPL.
11 MVE.
Planning
C
7•
❑OTHER
WORKLD. ❑ PLMB. ❑ MECH. ❑ M. H.
W
El POOL
Certifi. df Exempt.
Required
Yes❑ No 1-1
Number
or Variance
Received
Yes❑ No❑
8
DESCRIBE WORK
Shorelines/ Flood Hazard
Plans Require
0
��
A
Yes L1 Not Applic. ❑
Receive
VALUATION
I SOURCE
OF
GAS
EL CTRICWATER
PUBLIC
SEWAGE
SEPTIC
Ownership
FEES COLLECTED
9
UTILITIES
PRIVATE ❑
1 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 REWEIRSE SIDE FOR R UI INSPECTIONS
Plumbing
SIGNATURE OF APPLICATION
OWNER OR AGENT DATE Z—
Mach.
SPECIAL APPR V S
SPECIAL CONDITI N . (SEE REVERSE SIDE FOR NOTIC )
FI DATE
/1
LL (/ � �-700
�
Plan Check
Env. HealthPRELIM.
G
1 �' /
SEPA
Planning
Modular/
MFG. Home
` LI I Other (Specify)
Utilities
Pians, PERMIT IS NONTRANSFERABLE
Exam. �� t�/a� PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
Building 11 IN 180 DAYS
Buil
PERMIT NUMBER
� f3 ' -
TOTAL $
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
12-27 279,22 *436000j
DATE ISSUED PERMIT NO. TOTAL
CL
O
C.3
W
J_
tL
t F �4
fl,
(07'
091VE
10
Y'a
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