1983, 07-12 Permit: 83A-6412 Deck RoofPLAN NUMBER APPL I(CAT ION /PERMIT PERMIT NUMBER
SPOKANE COUNTY - DEPAR,rmENT OF BUILDING & SAFETY e,�)A - 6`24
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 3 COPIES
1 STREET ADDRESS I PARCEL NO. 14r
�p
'IMG/ �- — 0
LOT BLOCK SU�Dl SION LEGAL DESCRIPTION:
2. fes= LJ �
OWNER P PHONE
3.
MAILING ADDRESS_ 7 t Actual Set Backs m Feet to:
.115-2 (-� North South East West
CONT C O LICENSE EXPIRES PHONE Size of Parcel Zo eClas'ficetion Residential
U r Commercial ❑
4. ADDRESS ZIP Typg�_ rMst. Occupancy Sprinklered
v N
Dyes ❑No ❑Req'd.
DESIGNER PHONE New Const. yalyation Remodeled Valuation Total Bldg. Floor Area
5. CJfI
9 UTILITIES PRIVAT ❑ SEWER ❑ Public ❑ Private
I hereby certify that I have read and examined this application and have read the "NOTICE" provisions includedon
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 REVERSE SIDE FOR REQUIRED INSPECTIONS Plumbing
SIGNATURE OF �% jJ �/ APPLICATION
OWNER OR AGENT /L�t=r%'�'�G�61 ,�� t� DATE �' Mach.
SPECIAL APPROVALS SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PRELIM. FINAL DATE
Plan Check
Env. Health
SEPA
Planning
Modular/
MFG.Home
Fire
Prevent.
Plans�J PERMIT IS NONTRANSFERABLE
Exam. PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
Building —71:2 IN 180 DAYS
Tech.
Other (Specify)
TOTAL $
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
' z
DATED�%uED1 2 -8 " J PERMIT�1041, 2 z
*20.00"
Y
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C3
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ADDRESS
ZIP
Main Floor Upper
Floors
Garage/Storage
Greenhouse
CHANGE OF USE FROMTO
r
Uncv. Deck
Fin. Basement
Unfin. Basemi
6.
�--
No. the No.
Floors
No. Fin. Rooms
No. Dwellings
❑ N ❑ALT.
--
SAD' N. ❑RPL.
El MVE.
7•
OFPE
El OTHER
-T
WORK BLD. ❑ PLMB.
❑ MECH. ❑ M.H.
❑POOL
Certifi.ofExempt.
Required
Yes❑ No 1-1
Number
or variance
Received
Yes No El
8
DESCrIBE O K�
5�i I
f N
Shorelines/ Flood Hazard
Yes❑ Not Applic. ❑
Plans Required
Received
VALUATION
I SOURCE
OF
GAS
ELECTRIC
WATER
PUBLIC
SEWAG
SEPTIC
Ownership
FEES COLLECTED
9 UTILITIES PRIVAT ❑ SEWER ❑ Public ❑ Private
I hereby certify that I have read and examined this application and have read the "NOTICE" provisions includedon
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 REVERSE SIDE FOR REQUIRED INSPECTIONS Plumbing
SIGNATURE OF �% jJ �/ APPLICATION
OWNER OR AGENT /L�t=r%'�'�G�61 ,�� t� DATE �' Mach.
SPECIAL APPROVALS SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PRELIM. FINAL DATE
Plan Check
Env. Health
SEPA
Planning
Modular/
MFG.Home
Fire
Prevent.
Plans�J PERMIT IS NONTRANSFERABLE
Exam. PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
Building —71:2 IN 180 DAYS
Tech.
Other (Specify)
TOTAL $
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
' z
DATED�%uED1 2 -8 " J PERMIT�1041, 2 z
*20.00"
Y
CL
O
C3
W
J_
LL