1983, 10-05 Permit: 83A-9978 SidingPLAN NUMBER APPL ICAT ION /PERMIT
SPOKANE COUNTY — DEPARTMENT OF BUILDING & SAFETY
n NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES -PRESS HARD TO MAKE 3 COPIES
STREETADDRESS PARCEL NO.
1. C. l�c><twL., ti -s! -S4 I - at 1
2. LOT I BLOCK I SUBDIVISION LEGAL DESCRIPTION:
OWNER
PHONE
PHONE
to v% E-(
247
MAILING ADDRESS
ZIP
Actual Set Backs in Feet to:
15 .13`3 ';?-C=C—iCwGX..1_a21G�
North South East
West
CONTRACTOR
LICENSE EXPIRES
PHONE
Size of Parcel
Zone Classification
Residential ❑
4. "A'_
Commercial ❑
ADDRESS
ZIP
Type Const. Occupancy
Sprinklered
s
❑Yes ❑No ❑Req'd.
DESIGNER
PHONE
New Const. Valuation
Remodeled Valuation
Total Bldg. Floor Area
5.
ADDRESS
ZIP
Main Floor Upper
Floors
Garage/ Storage
Greenhouse
CHANGE OF USE FROM
TO
Cover Deck
Uncv. Deck
Fin. Basement
Unfin. Basement
s.
TYPE
No. Baths No.
Floors
No. Fin. Rooms
No. Dwellings
11 NEW El ALT. El AD'N. RPL. El MVE.
7• OF ❑ OTHER
WORK LLD. ❑ PLMB. ❑ MECH. ❑ M.H. ElPOOL
Certifi. of Exempt.
Required
Yes❑ No❑
Number
or Variance
Received
Yes❑ No❑
DESCRIBE WORK
8'
Shorelines/ Flood Hazard
Plans Required ❑
---,16, P,)c, ,
yes Not Applic. ❑
Received ❑
,VALUATION
9• ' 7 50
SOOURCE
GAS
ELECTRIC
PUBLIC ❑
SEPTIWATER C ElOwnership
FEES COLLECTED
UTILITIES
PRIVATE ❑
SEWER ❑
Public ❑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
70-00work
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 REVERS IDE FOR REOUtSED IWSPECTIONS
Plumbing
SIGNATURE OF APPLICATI N
'
§>*OWNER OR DATE
J_^ ? �' Q��
Mach.
Env. Health
Planning
Prevent
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
SPECIAL CONDIT
(SEE REVERSE SIDE FOR NOTICE)
PERMIT IS NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
Plan Check
SEPA
PERMIT NUMBER
Modular/
MFG. Home >.
a
C
Other (Specify) v
W
J
TOTAL $ 2�
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATE IiIOE'ff 0 5-8 3 PERMIT N09 Z 8 Z
*20.00,,
T TAL
LL