1983, 06-15 Permit: 83A-5325 Residence PLAN NUMBER APPLICATION/PERMIT PERMIT NUMBER '
S3 `Cad SPOKANE COUNTY — DEPARTMENT OF BUILDING & SAFETY • - S`3A - S�a-S
CNORTH 811 JEFFERSON /SPOKANE,.;.VASHINGTON 99260/(509)456-3675
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
STREET ADDRESS PARCEL NO. e�
1. S. 1(10 iq o(AtmoN'T Da . Z`J t- O4(O
LOT BLOCK SUBDIVISION LEGAL DESCRIPTION:
2. I0 4 9, -t f.3T E rt tcs 't0 a,
OWNER PHONE PHONE
3. i cf`rtA lav Ec.o•P V .\) q28 as(vs
MAILING ADDRESS ZIP
Actual Set Backs in Feet to:
4,. —P,"..1cS (441 .00 North eel JSouth t p` East I West 'Sc)'
CONTRACTOR . LICENSE EXPIRES PHONE Size of Parcel Zone Classification Residential 111
4. 'ick`^`F 11 U X 7...o 12.-i Commercial 0
ADDRESS k ZIP Type Const. Occupancy Sprinklered
' AMC, ` -St-h4 .12,' Jjv1.-1 ❑Yes ❑No ❑Req'd.
DESIGNER PHONE Const.Valuation Remodeled Valuation Total Bldg.Floor Area
5. 12, 006. 7..Z14-
..
ADDRESS ZIP Main Floor Upper Floors Garage/Storage Greenhouse
15+2. (-7 z —
CHANGE OF USE FROM TO Cover Deck Uncv.Deck Fin.Basement Unf in.Basement
6. -SZ MZ. -&2"'2
TYPE No.Baths No.Floors No.Fin.Rooms No.Dwellings
/NEW ❑ ALT. ❑ AD N. ❑ RPL. ❑ MVE. Z, I 6 1
7 WORK OF
® BLD. ❑ PLMB. ❑ MECH. ❑ M.H. ElPOOL ❑ OTHER Certifi.ofExempt. Required Yes El NI Number
or Variance Received Yes No❑ '"-----
DESCRIBE WORK Shorelines/Flood Hazard Plans Required 6
8• ...--3.,...,t,4E FF}w..L L`J 5;( x mac, Yes❑ Not Applic.0 Received ❑
VALUATION SOURCE I GAS ELECTRIC PUBLIC RI� SEPTIC❑/SEWAGE Ownership / FEES COLLECTED
9 UTILITIES PRIVATE 0 SEWER✓a Public 0 Private ff
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 4) .O
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 R,1EVE E SIDE FOR REQII''jy1iJ/�/�•��Ep. II SPECTIONS G Plumbing
SIGNATURE OFOWNER OR GENT I` `" "" DATEAPPLI ,4
, _, f/ Mech.
SPECIAL APPROVALS SPECIAL CONDITIONS:(SEE REVERSE SIDE FOR NOTICE)
PRELIM. FINAL DATE Plan Check
Env.Health
',!A SEPA
Planning
Modular/
Fire MFG.Home
Prevent. a
I Engineer Other(Specify) v
ifkg\/ _
_W
Utilities
TOTAL $�6
SEPA ti
LL
WHEN MACHINE V
Plans �,�� Amy PERMIT IS NONTRANSFERABLE THIS BECOMES AE PERMIT.VALIDATED IN THIS SPACE,
Exam. /�j/� K/!'— PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
Building IN 180 DAYS _
Tech. Q ((''�� �� 0
//1 21 DATE'J531JED1 7 0 3 PERMITI�1& .5 z *415. 0 JO
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