1983, 07-19 Permit: 83A-6690 OfficePLAN NUMBER
APPLICATION/PERMIT
SPOKANE COUNTY — DEPAATMENT OF BUILDING & SAFETY
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
T7. YPE
No. BathsNo.
APPLICANT: COMPLETE NUMBERED SPACES —PRESS HARD TO MAKE 3 COPIES
No. Fin. Rooms
No. Dwellings
STREET ADDRESS
rtV
PARCEL NO.
El OTHER
WORK BLD. ❑ PLMB. ❑ MECH. ❑ M.H. ❑ POOL
LOT
2. r
BLOjK
Z7
su D�IVaISION
I —4off:: a�l� i7 �'�
,H
LEGAL DESCRIPTION:
Received Yes❑ No❑
G�
DESCRIBE WORK��aa�
d'{% �71✓�
OWNER
S
ro Li,�
PHONE
- G860
PHONE
Received ❑
VALUATION
LJ
I SOU E
LI
3.
ELECTRIC
I WATER
PUBLIC
SEWAGE/
SEPTIC Lel
Ownership
Public ❑ Private
FEES COLLECTED
11
UTILITIES
MAILING ADD
N 1`717
ZIP
� 21
Actual Set ks in Feet to:
North South
East *5 West
CONTRA TO
7,
reverse side, and know the same to be true and correct. All provisions of laws and ordinances governing this type of
LICENSE EXPIRES
PHONE
Size ofParce
I �U
ZoneClassifica�tj'on
Residential /�
Commercial
4.
SIGNATURE OF APPLICATION'
Plans
OWNER OR AGENT DATE
Mach.
{ X
F f (Nb
.
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
ADDRESS
ZIP
Type ns
NK
Occupa cy
1;;� 12 ;�_
Sprinklered
❑Yes )lo
❑Req'd.
DESIGNER
DATETrrII S%UE�
PHONE
New Const. Valuation
Remodeled Valuation
Total Bldg. Floor Area
5
5I IS G
ADDRESS
ZIP
Main Floor
Upper Floors
Garage/Storage
Greenhouse
6.
CHANGE OF USE FROM
TO
Covar Deck
Uncv. Deck
I
Fin. Basement
Un n. Basgment
Z C(J/,
T7. YPE
No. BathsNo.
Floors
No. Fin. Rooms
No. Dwellings
NEW El ALT. ❑ AD' N. ❑RPL. ElMVE.
rtV
-51 V_ I
El OTHER
WORK BLD. ❑ PLMB. ❑ MECH. ❑ M.H. ❑ POOL
Certifi. of Exempt.
Required Yes El NoTr
Number
,H
or Variance
Received Yes❑ No❑
G�
DESCRIBE WORK��aa�
d'{% �71✓�
Shorelines/Flood Hazard
Plans Required
Lr�
Yes❑ NotApplic.H'
Received ❑
VALUATION
LJ
I SOU E
LI
GAS
ELECTRIC
I WATER
PUBLIC
SEWAGE/
SEPTIC Lel
Ownership
Public ❑ Private
FEES COLLECTED
11
UTILITIES
Utilities
PRIVAT ❑
SEWER ❑
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 compiled with whether specified herein or not. The granting of a permit does not presume to give au-
thority to violate or cancel th visions of any other state or local law regulating construction or the performance
of construction. SEE REV SE SDE FOR REOUIMP IN E IONS
Plumbing
SIGNATURE OF APPLICATION'
Plans
OWNER OR AGENT DATE
Mach.
SPECIAL APPROVALS - SPECIAL CONDITIONS: (9EE REVERSE SIDE FOR NOTICE)
PERMIT UMBfrR
PERMIA4. 9. 0 z * 3 3 4 0 0 1001-F�AL
0
C
C
U
U
PRELIM. FINA
ATE
Plan Check
Env. Health
SEPA
Planning
G�
`/ ✓ 3t ? ! �y
eu a _ / / `• 1 y, ,
Modular/
MFG. Home
FireCR
Prevent.
iL�Zi�-+Li�i' l
Other (Specify)
Engineer
n
11
?1li5 Ps�s� � �:�Sr•E�r-�cT��v �s ,ro,� ,a ,�s�A� �
TMSF 6'kVAAWVVC 4s drl.4oe7E;il2s' Aebe Ca$roP IA74
Utilities
?Wv25'`T/i✓W Idr/GL +41'G5 ,G !6-0 Cit/m6!G
TOTAL $
SEPA
.4-010 W.UZ
'C.4�i0 /%c .�ClJfii>}pNONTRANSFERABLE
WHEN MACHINE VALIDAT
THIS BECOMES A PERMIT.
Plans
1
Exam.
�
�i�^
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
Building
Tech.
(p
IN 180 DAYS
9 — 8 3
/
DATETrrII S%UE�
PERMIT UMBfrR
PERMIA4. 9. 0 z * 3 3 4 0 0 1001-F�AL
0
C
C
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