1983, 05-04 Permit: 83A-3615 GaragePLAN 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
STREET ADDRESS
1. 74=2_iti
2.BLOCSUBDIVISION
°F19.' 1\11 elki 01\15:4 5
3 OWmt�1 -7i05"
L'JTI PHONE
4.
MA NG ADDRESS
i I 2.0
CO TCT
ADDRESS
LICENSE EXPIRES
PHONE
PARCEL NO. i
0541 C1
03
LEGAL DESCRIPTION:
Actual Set Backs in Feet to:
North 77 (South
ZIP
SizParcel
I of o?‹.
Type s J
East
Zqne plassifica io
West
Residential
Commercial ❑
incy
Sprinklered
❑Yes ❑No ❑Req'd.
DESIGNER
5.
ADDRESS
PHONE
New Const. Valuation
Remodeled Valuation
Total Bldg. Floor Area
ZIP
Main Fl
Upper Floors
Garage/ torax
Greenhouse
CHANGE OF USE FROM
6.
TO
Cover Deck
Uncv. Deck
Fin. Basement
Unfin. Basement
TYPE )' W ❑ ALT. ❑ AD' N. 1=1 RPL. ❑ MVE.
7. OF N LD. ❑ PLMB. ❑ MECH. ❑ M.H. ❑ POOL
WORK
❑ OTHER
No. Baths
No. Floors
No. Fin. Rooms
No. Dwellings
Certifi. of Exempt.
or Variance
Required Yes❑ No❑
Received Yes ❑ N ❑
8.
DESK
VALUATION
9.
SOURCE
F
UTILITIES
GAS
ELECTRIC
PUBLIC.��
PRIVATE ❑
SWAGE
SEPTI
SEWS ❑
Shorelines/Flood Hazard
Yes ❑ NotApplic. ❑
Ownership zr
Public ❑ Private
Number
0
Plans Required
Received
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 FOR REQUIRED INSPECTIONS
SIGNATURE OF
OWNER OR AGENT !l
AATECATION7� r3
SPECIAL APPROVALS SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PRELIM. FINAL DATE
Env. Health
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
5-3
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)
toI
TOTAL $
PERMIT NUMBER
IS
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATEYSSUEcP 4_ 0 3 PERMIT'N8.
*61.0OFAL
rioiel