1983, 05-17 Permit: 83A-4191 ResidencePLAN N MBER APPLIICATION /PERMIT
g SPOKANE COUNTY - DEPARTMENT OF BUILDING & SAFETY
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
1. g.
LQT
2.
OWNER
3.
MAILING
4.
4. 7
ADDRESS
DESIGNEI
5.
ADDRESS
APPLICANT: COMPLETE NUMBERED SPACES -PRESS HARD TO MAKE 3 COPIES
A46 PARCEL NO. (:524 "J 4-4- _ I
SUBDI SION LEGAL DESCRIPTION:
PHONE
�1 7
LICENSE EXPIRES
PERMIT NUMBER
63A 411 I[
CHANGE OF USE FROM
North South Q EastZ West I 3
HONE
Size of Parcel
Zone Classification
ResidentialefT
(� i
I
.
Commercial C
ZIP
Typest
pan
Sprinklered
TYPE W ❑ ALT. ElAWN. ❑ RPL. 11MVE.
No. Baths
'
❑Yes ❑No ❑Req'd.
PHONE
New Const. Valuation
emodeled Valuation
Total Bldg. Floor Area
% OF ❑OTHER
I
ZIP
Main Floor
Upper Floors
Garage/Storage
Greenhouse
Certifi. of Exempt.
Required
Yes❑ No❑
'7_t'].c.
PERMIT NUMBER
63A 411 I[
CHANGE OF USE FROM
TO
Cover Deck Uncv. Deck
Fin. Basement
Unfin. Basement
6.
_
TYPE W ❑ ALT. ElAWN. ❑ RPL. 11MVE.
No. Baths
No. FlgOrs
No. Fin. Rooms
No. Dwellings
% OF ❑OTHER
I
WORK BLD. ❑ PLMB. ❑ MECH. ❑ M. H. ❑ POOL
Certifi. of Exempt.
Required
Yes❑ No❑
Number
or Variance
Received
Yes[] No❑
DESCRIBE WOR�K� �j
8.
Shorelines/ Flood Hazard
Plans Required Pf
Yes Not Applic. ❑
Received ❑
VALUATMJN
SOOUFCE
G S
ELECTRIC
pUB ICR
SEPT CGE
Ownership
FEES COLLECTED
9•
UTILITIES
PRIVATE ❑
SEWER ❑
Public ❑ Privat
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 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 SVOEFOR REQUIRED INSPECTIONS
Plumbing
SIGNATURE OF APPLICATION'
OWNER OR AGENT DATE
Mech.
SPECIAL APPROVALSSPECIAL
NDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PRELIM. FINAL D E
Plan Check
Env. Health
7
SEPA
Planning
Modular/
MFG. Home
>
Fire
Prevent.
C
C
Engineer
L
Other (Specify)
L
Utilities
`
TOTAL $�'r�
SEPA
WHEN MACHINE VALIDATED IN THIS SPACE,
Plans
PERMIT IS NONTRANSFERABLE
THIS BECOMES A PERMIT.
Exam.
�
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
Building
Tech.
I N 180 DAYS
(� �j 1 �7 j 4 l z
/ 8
* ` " 8' O 0 a F -
DATE ISSUED+ PERMIT N6
TOTAL
V 117E T�
P T -A A -j
t rJ
So oz rtoIQ
= L. 9F, C^N N d
1 �
802,
pr
r
y
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Y
®fLI V,
Ar
T
G o Nc . �• t�� �
�d .w d ...�,i t� :a� 'e -7�.j +._.;_k,.i:= �'.. i • l-.i.l i
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