1983, 04-04 Permit: 83A-2550 Residence AdditionPLAN 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
1.
KEu.z✓ 9—
LOT
2.
BLOCK
SUBDIVISION
3.
4.
OWNER
MIN fay._
MAILING ADDRESS
TsJ 5 I %
CONTRACTOR
5T6(ZtU
PHONE
PHONE
PARCEL NO.
34<d1$—
LEGAL DESCRIPTION:
ZZIIP
/?
`''142. 1(v
LICENSE EXPIRES
PHONE
21(0-6i4C..
Actual Set Backs in Feet to: •
North --- 'South -- {East ..--I West
Size of Parcel
Zong Classification
Residential IV
Commercial ❑
ADDRESS
ZIP
Type Const.
Occupancy
Spr'nklered
❑Yes ❑No Reg 'd.
DESIGNER
5.
ADDRESS
PHONE
N Const. Valuation
Remode ed Valuation
Total Bldg. Floor Area
ZIP
Main Floor
"2.1
Upper Floors
Garage/Storage
Greenhouse
CHANGE OF USE FROM
6.
TO
Cover Deck
Uncv. Deck
Fin. Basement
Unfin. Basement
TYPE ❑ NEW ❑ ALT. "AD' N.
7. OF (BLD. 0 PLMB. 0 MECH.
WORK
O RPL.
O M.H.
O MVE.
O POOL
0 OTHER
No. Baths
No. Floors
k
No. Fin. Rooms
Certifi. of Exempt.
or Variance
Required
Received
Yes❑ No/
Yes❑ Noll
No. Dwellings
Number
DESCRIBE WORK
8. Ant>, rs.c -Tr) {DErvC
&x?)
Shorelines/Flood Hazard
Yes Not Applic. ❑
Plans Requ"red ❑
Received ❑
VALUATION
9.
SOURCE
UTILITIES
GAS
ELECTRIC
WATER
PUBLIC ❑
PRIVATE ❑
SEWAGE
SEPTIC E
SEWER ❑
Ownership
Public ❑ Private
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-
thority to violate or cancel the provisions of any other state or local law regulating construction or the performance
of construction. SEE REVERSE SIDEFORREQUIRED INSPECTIONS
SIGNATURE OF OWNER OR GENT ` `l, �t�(i`(�`�" DATE
CATIQN I�
SPECIAL APPROVALS SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PRELIM. FINAL DATE
Env. Health
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
9r?
4418.3
-s 0N54TO
NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
FEES COLLECTED
Building iaO.C�
Plumbing
Mech.
Plan Check
SEPA
Modular/
MFG. Home
Other (Specify)
TOTAL $ c'f,
PWR .4IT NUMBER
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATE liSdED 0 4 - 8 3
PERMIT 1205 5.0 z
*2 0.0 . UTGTIAL