1983, 09-07 Permit: 83A-8705 ResidencePLAN 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
STREETADDRESS IPARCELNO.
LOT BLOCK SUBDIVISION 1LFAAL DFSCRIPTION•_
2. ZI I Z lit tc:ta �A
OWNER
3
MAILING ADDRESS
S - 40-2— iia r\
CONTRACTOR
4. ''
ADDRESS
u
PHONE PHONE
46,8
ZIP
01'anx
LICENSE EXPIRES PHONE
ZIP
Actual Set Backs in Feet to:
North South Zr¢ East ZJ West
Size of Parcel ZoneCi�ication Residential Li
I 12Q Commercial G
T L Occupancy Sprinklered
SPECIAL APPROVALS SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PRELIM. FINAL DATE
Env. Health e/
Planning
Prevent.
Utilities
SEPA
AA
Plans PERMIT IS NONTRANSFERABLE
Exam. ��13 PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
Building
Tech. IN 180 DAYS
,3/
Plan Check
SEPA
Modular/
MFG. Home
Other (Specify)
TOTAL $ 33&-V
PERMIT NUMBER
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS
(�BECO(�MES A PERMIT. 7 f'
DATEYS2 'v _ -81 'v
PERMI"O. 0. 5 z * 3 3 8. 0 0 SAL
4
C
G
u
u
-(
❑Yee ❑No ❑Req'd.
__FDESIGNER'
PHONE
Const. Valuation
Remodeled Valuation
Total Bldg. Floor Area
5.
ADDRESS
ZIP
Main Floor Upper
Floors
Garage/Storage
Greenhouse
its Lf
—
1
(040
CHANGE OF USE FROM
TO
Cover Deck
Uncv. Deck
Fin. Basement
Unfin. Basem
6.
—
1A c>
LIX4
/
TYPE
1t°' No.
Floors
No. FIRooms
No. Dwellings
C� ❑ ALT. ❑ AD' N. ❑ RPL. ❑ MVE.
/NEW
7. OF ❑OTHER
WORK C±f'BLD. ❑ PLMB. ❑ MECH. F-1M.H. ❑ POOL
Cartifi. of Exempt.
Required
Yes❑ Noe
Number
or Variance
Received
Yes❑ No❑
_
8. DESCRIBE WORK
Shorelines/ Flood Hazard
Plans
Required
t �C�i
Yes❑ Not Applic. ❑
Received e
VALUATION
9
SOURCE
GAS
ELECTRIC
PUBLICR
SEPTAL
Ownership r
FEES COLLECTED
UTILITIES
PRIVATE ❑
SEWER ❑
Public ❑Private fd
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
2
J QO
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 REVERS SIDE FOR REQUIRED INSPECTIONS
Plumbing
SIGNATURE OF ,' ' / APPLICATION
OWNER OR AGENT —__/I t'yt�CY/ DATE �_
Mach.
SPECIAL APPROVALS SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PRELIM. FINAL DATE
Env. Health e/
Planning
Prevent.
Utilities
SEPA
AA
Plans PERMIT IS NONTRANSFERABLE
Exam. ��13 PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
Building
Tech. IN 180 DAYS
,3/
Plan Check
SEPA
Modular/
MFG. Home
Other (Specify)
TOTAL $ 33&-V
PERMIT NUMBER
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS
(�BECO(�MES A PERMIT. 7 f'
DATEYS2 'v _ -81 'v
PERMI"O. 0. 5 z * 3 3 8. 0 0 SAL
4
C
G
u
u
PL 0 T PLR /'v
N o---
Z o -r
L-1 7,3 .rc /O.00
///7 M%(N P Ikk ORI (/16