1983, 01-21 Permit: 83A-0553 Finish BasementPLAN 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 PARCEL NO.
LOT BLOCKAOL
Bol IS�IONt�r j LEGAL DESCRIPTION:
OW R
UTILITIES
I 1 A-5
Li
J SI
P
PHONE
3.
Total Bldg. Floor Area
Main Floor
Upper Floons
Garage/Storage
MA.IyNG IDI E
Ower Deck
✓
Fin. Basement
Unfin. Basement
COR CTO
4.
No. Floors
No. Fin. Rooms
LICENSEEXPIRES
PHONE
ADDRESS
OWNER OR DATE Z /
Mach.
ZIP
DESIGNER
Required YwO NoO
Number
PHONE
5.
Received Yes❑ No❑
Shorelines/Flood Hazard Plans Required 0
ADDRESS
ZIP
CHANGE OF USE FROM
TO
SEPA
6.
TYPE 0�
ALT. ❑ AD'N.
El RPL. 0 MVE.
/NEW
i
•Id
❑OTHER
WORK Jd BLD.
0 PLMB. 0 MECH.
0 M.H. 0 POOL
Set Backs in
West
Sim of Parcel
JN
UTILITIES
I/�I
OYes ON. OReq'd.
New Const. Valuation
Remodeled Valuation
Total Bldg. Floor Area
Main Floor
Upper Floons
Garage/Storage
Greenhouse
Ower Deck
Unw. Deck
Fin. Basement
Unfin. Basement
No. Baths
No. Floors
No. Fin. Rooms
No. Dwellings
SIGNATUREOF APPLICATION
ZEN
OWNER OR DATE Z /
Mach.
Certifi.of Exempt.
SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
Required YwO NoO
Number
orvarlanoe
Plan Check
Received Yes❑ No❑
Shorelines/Flood Hazard Plans Required 0
S• V ew.T I Yes❑ Not Applic.D Received ❑
VALUATION I SOURCE GAS ELECTRIC I WATER SEWAGE Ownership
GF PUBLIC ❑ SEPTIC D -FEES COLLECTED
9• 1 OCI0
UTILITIES
PRIVATE 0
SEWER ❑
1 Public 0 Private ❑
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-
Building
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 REOU RED INSPECTIONS
Plumbing
SIGNATUREOF APPLICATION
ZEN
OWNER OR DATE Z /
Mach.
SPECIAL APPROVALS
SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PRELIM. FINAL DATE
/ �t �J{ I
(l +'�( I
LL I r I
Plan Check
Em. Health
\
5 7 �.�./1
SEPA
Planning
Modular/
MFG. Home
Utilities
SEPA
Plans PERMIT IS NONTRANSFERABLE
Exam. PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
Bul�dmg n I1 IN 180 DAYS
Other (Specify)
40 -
P ERMIT VUM BER� 2
02* *2000
*20.00
A *000 00
5522
01-21-83
2 6479.
TOTAL $
WHEN MACHINE VALIDATED IN THIS SPACE
THIS BECOMES A PERMIT.
DATE ISSUEbL 1�1 to / PERMIT N05'5.5 z
* 2 0.0 OTU IAL
LL