1983, 03-16 Permit: 83A-1921 ResidencePLAN NUMBER
'o41
(7)
APPLICATION/PERMIT
SPOKANE COUNTY — DEPARTMENT OF BUILDING & SAFETY
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
1.
2.
STREET ADDRESS
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
a
. 17 oA- f� 1•Ji(
LOT BL K SUBDIVIS
IO
15
OWNE
MA LING A
I
82 2-j 5
3 �. KI%6 tl 16
DRESS
C^ONTjRJ AR 1.16
4. s
ADDRE
PHO E
72-6 -4-933
PHONE
PARCEL NO. 6r (_ 01 C ros.-rrof
1
LEGAL DESCRIPTION: I J
& s? -
Actual Set ks in Feet to:
North I I South 12--
LICENSE EXPIRES
PHONE
Size f,parx
I
Ina
East
>Z�G
west :2.7
!cation
Residential
Commercial ❑
ZIP
Type o Jt.
DESIGNER
J. ADDRESS
PHONE
Occupan y
E. Rem Ie ed Valuation
New Const. Vation
l5
Sprinklered
❑Yes ❑No Req 'd.
Total Bldg. Floor Area
ZIP
6.
CHANGE OF USE FROM
TO
Main Floor
1 � Cover c
Upper Floors
TYPE NEW ❑ ALT. ❑ AD' N. ❑ RPL. ❑ MVE.
7 OF WORK LD. ❑ PLMB. ❑ MECH. ❑ M.H. ❑ POOL ❑ OTHER
No. Baths
3
Uncv. Deck
No. Floors
2 -
Garage/Storage
(7Z
Greenhouse
Fin. ement
Unfin. Basement
No. Fin. Dooms
No. Dwellings
Certif1. of Exempt.
or Variance
Required Yes❑ No❑
Received Yes No❑
Number
8. DES MBE W013.1
0.1\
V G&
VALUATION SOURCEDG S ELECTRIC
9 UTIF
LITIES
Shorelines/Flood Hazard
Yes❑ NotApplic. ❑
Plans Required/
Received �/
WATER
PUBLIC
PRIVATE ❑
SEWAGE
SEPTIC
SEWER D
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 SIDE FOR REQUIRED INSPECTIONS
SIGNATURE OF--�--.� (� APPLICATION
OWNER OR AGENT.--�'
O--�-a'J DATE
SPECIAL APPROVALS
PRELIM. FINAL DATE
Env. Health
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
3 r
A51�1: , 31®+ 3 Sp- ez -Z/5 P'i- ,6 z/243 j"1(
r(ofg.
34,
5
8
PERMIT IS NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
3
FEES COLLECTED
Building
Plumbing
Mech.
Plan Check
SEPA
Modular/
MFG. Home
Other (Specify)
TOTAL
s
PERMIT NUMBER
)1\ 1Y% I
A
19
*39800
398,006
*0.00
-16-83
6.479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
03-16-83
DATE ISSUED
19215 *598,O0aI-
PERMIT NO. TOTAL