1983, 03-09 Permit: 83A-1647 MH CoverPLAN NUMBER
APPLICATION/PERMIT
SPOKANE COUNTY — DEPARTMENT OF BUILDING & SAFETY
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
APPLI
CANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
1.
STREET ADDRESS
E 184.11
tC3etz-c`i
?ARCEL NO.
c:'c '-( — \ �..
2.
3.
LOT
iZ
OWNER
LtJ A
BLOCK
SUBDIVISION
E.AS i`
VV1 A t2Tl
PHONE
PHONE
tel
LEGAL DESCRIPTION:
MAILING ADDRESS
®4k -t‘ L tcE42..ct
ZIP
Actual Set Backs in Feet to: iG:xi�
North 1South I East
West
4.
5.
CONTRACTOR
ZAlvve
ADDRESS
SArttc-
DESIGNER
LICENSE EXPIRES
PHONE
Size of Parcel
Sc�xt►S
Zone Classification
lvtJ
Residential H
Commercial ❑
ZIP
Type Const.
Occupancy
Sprinklered
❑Yes 0 N ❑ Req 'd.
PHONE
ADDRESS
ZIP
New Const. Valuation
'Z
Main Floor
Remodeled Valuation
Total Bldg. Floor Area
Co
Upper F oors
Garage/Storage
Greenhouse
CHANGE OF USE FROM
6.
TO
Cover Deck
Uncv. Deck
Fin. Basement
Unfin. Basement
TYPE Q NEW ❑ ALT. ❑ AD' N.
7. OF Ig BLD.
WORK
❑ PLMB. ❑ MECH.
❑ RPL.
❑ M.H.
❑ MVE.
❑ POOL
❑ OTHER
No. Baths
No. Floors
No. Fin. Rooms
No. Dwellings
Certifi. of Exempt.
or Variance
Required Yes❑ No E7'
Received Yes No
Number
DESCRIBE WORK
8. :io w.c.
VALUATION
9.
SOURCE
UTI LLIITI ES
Cauca.
GAS
ELECTRIC
WATER/
PUBLIC til
PRIVATE ❑
SEWAGE
SEPTIC lir
SEWER ❑
Shorelines/Flood Hazard
Yes Not Applic. ❑
Ownership
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
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 REVER E SIDE FOR REQUIRE ' NSPECTIONS
��
SIGNATURE OF 1 // APPLICATIOfJ
OWNER OR AGENT -�n�%�E1►_ A.m./. f.rr. DATE '`
SPECIAL APPROVA
PRELIM. FINAL
LS
DATE
Env. Health
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
q74
SPFI-
SPEC ONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
Af9Q.D4 d'O
(.c:( -C e •.i
1, ISA) `z i$''eERMIT IS NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
Plans Required
Received R
FEES COLLECTED
Building 41'4;7'Citir
Plumbing
Mech.
Plan Check
SEPA
Modular/
MFG. Home
Other (Specify)
TOTAL $ 4-71Z)
PERMIT NUMBER
e -V„,¢-1
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATE 1640 0 9 _8 3
PERMIT( 4. 7
* 4 7.0 0 fOtAL