1983, 02-24 Permit: 83A-1280 MHPLAN 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
1 s EETADDR SS � PARCEL NO. 1215-34
i
_ LQTr BWCK I SUBPNSION i w,.—LEGAL DESCRIPTION:
L/ ✓ ' I /V i
O Rc P ON PHONE
PE*A KI J
MAILING ADDRE _ _f I ZLP _ _ Actual Set Backs in Feet to:
SPECIAL APPROVALS SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
Env. Health
PRELIM. FINAL DATE
v
Planning 0,360
Fi re
Prevent.
Utilities
SEPA
Plans I PERMIT IS NONTRANSFERABLE
Exam. PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
Building21� IN 180 DAYS
Tech. r
Plan Check
SEPA
Modular/
MFG.Home So
Other (Specify)
PERMIT NUMBER
83 A - t -)L-00
TOTAL $
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATE"I D� 4 — 8 3 PERMIT N� 8' O Z * 5 fb AL
O
C
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T�—
North ISOuth I PD I East
IWest
C TAT R
LfCENSE EXPIRES
PHONE
Size o� Parcel
Zoe I ification
Residential P/
2-
fa
Commercial ❑
4.
ADDRESS
ZIP
Typ�C�r�st.l
O&
ngy
Sprinklered
❑Yes ❑No ❑Req'd.
DESIGNER
PHONE
New Const. Valuation
Remodeled Valuation
Total Bldg. Floor Area
5.
ADDRESS
ZIP
Main Floor
Upper Floors
Garage/Storage
Greenhouse
CHANGE OF USE FROM
TO
Cover Deck
Uncv. Deck
Fin. Basement
Unfin. Basement
6.
No. Baths
No. Floors
No. Fin. Rooms
No. Dwellings
TYPE NEW El ALT. El AWN. El RPL. ❑ MVE.
7. ❑OTHER
WORK ❑ BLD. ElPLMB. ❑ MECH. 21M. H. ElPOOL
Certiff.ofExempt.
Required
Yes❑ No❑
Number
or Variance
Received
Yes❑ No❑
D S RIBE ORKy p
8•
!/S l��
4— Shorelines/Flood Hazard
Plans Required ❑
, ®('14�
° GPa,
Yes Not Applic. ❑
Received ❑
VALUATION
RCE
GAS
ELECTRIC
PUBLICR
SSETICOwnership
FEES COLLECTED
9•
UTILITIES
PRIVATE ❑
SEWER ❑
Public ❑ Private0�r
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-
Building
thority to violate or cancel t rovisions of any other state or local law regulating construction or the performance
of construction. SEE REVEASe SIDE FOR R RE PECTIONS
Plumbing
SIGNATURE OF APPLICATION
OWNER OR AGENT DATE
SPECIAL APPROVALS SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
Env. Health
PRELIM. FINAL DATE
v
Planning 0,360
Fi re
Prevent.
Utilities
SEPA
Plans I PERMIT IS NONTRANSFERABLE
Exam. PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
Building21� IN 180 DAYS
Tech. r
Plan Check
SEPA
Modular/
MFG.Home So
Other (Specify)
PERMIT NUMBER
83 A - t -)L-00
TOTAL $
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATE"I D� 4 — 8 3 PERMIT N� 8' O Z * 5 fb AL
O
C
C
LI
U
/7//
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