1983, 11-01 Permit: 83B-1175 InsertPLAN NUMBER APPL IICAT ION /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 AD Ess PARCEL NO.
2. LOT BLOCK I SUBDIVISION LEGAL DESCRIPTION:
. LIN AD gl� v�7 /,� �/� y [ /� rJ
�.7 161 V 9L,6,
ZIC10:5.7
0
Actual Set Backs in Feet to:
f / t el C Av
:5 .7
North South East
West
CON RACTO /
LICE S PIRES
PHONE
Size of Parcel
Zone Classification
Residential ❑
4.i�
Commercial ❑
ADDRESS` p���
ZIP
/
47
Type Const. Occupancy
Sprrte ❑Req'd.
Dyes❑No
j
Y2O
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 XNEW 1:1 ALT. 0 AD'N. El RPL. El MVE.No.
Baths No.
Floors
No. Fin. Rooms
No. Dwellings
7. WORK ❑ BLD. ElPLMB. IXMECH. ElM.H. El POOL El OTHER
OF
Certifi.ofExempt.
Required
Yes❑ No❑
Number
or Variance
Received
Yes❑ No❑
DESCRIBE WORK ./ „/_ jj �I
8. f
Shorelines/ Flood Hazard
Plans Required ❑
K( r ( a C kt !� Se/
14
Yes Not Applic. ❑
Received ❑
VALUATION
9•
I SOURCE
GAS
ELECTRIC
PUBLIC O
SEWAGE
0
1
Ownership
FEES COLLECTED
UTILITIES
PRIVATE ❑
SEWER ❑
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-
Building
thority to violate or cancel the provisions of any other state or local law regulating construction or the performance
of construction. SEE REVX&P4E SIDE FOR REQUIRED INSPECTIONS
/
Plumbing
SIGNATURE OF APPLICATION ) /
�/ !!!
20,
OWNER OR AGENT DATE
Mach.
SPECIAL APPR LS SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PRELIM. FIVAL DATE
Env. Health
Planning
Fire
Prevent.
Utilities
SEPA
PlansPERMIT IS NONTRANSFERABLE
Exam. PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
Buildingi 1 1 I N 180 DAYS
Tech. i
Plan Check
SEPA
Modular/
MFG.Home
Other (Specify)
PERMIT NUMBER 11_
63 -,'51e;63 -,'51e;-11-75
TOTAL $ I
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
l l" n 5 1 1
DATE ISSUEDO l _ Fl 5 PERMITNO. o
*20.00%liAL
O
C
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