1983, 01-25 Permit: 83A-0615 Relocate Meter, Piping PLAN NUMBER APPLICATION/PERMIT PERMIT NUMBER
SPOKANE COUNTY — DEPARTMENT OF BUILDING &SAFETY 63A- " `'`3
C)C j NORTH 811 JEFFERSON/SPOKANE,WASHIIJGTON 99260/(509)456-3675
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
STREET ADDRESS PARCEL NO.
1. c :Cs+ O c e-
LOT BLOCK SUBDIVISION LEGAL DESCRIPTION:
2. L, (1 * * 1 2 + 0
OWNER PHONE PHONE * 1 G, 0 0
3. k,F.:7L.><- ).% G'fz4=33P
MAILING ADDRESS ZIP Actual Set Backs in Feet to: it * C ( b
North (South `East I West F I, d _r
CONTRACTOR LICENSE EXPIRES PHONE Size of Parcel Zone Classification Residential❑
A ivc -.t 6'tt 1/4
. q Z4 `cP57 Commercial❑ 0 1 -2 5- s'
4. ADDRESS ZIP/, Type Const. Occupancy Sprinklered
(+ . k 04e t "C"N ciciz ❑Yes ❑No ❑Req'd• .r 6 4 7 C
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
6.
No.Baths No.Floors No.Fin.Rooms No.Dwellings
TYPE 0 NEW VALT. 0 AD'N. 0 RPL. 0 MVE.
7. OF ❑ OTHER
WORK
0 BLD. 0 PLMB. I'MECH. ❑ M.H. 0 POOL Certifi.of Exempt. Required Yes No❑ Number
or Variance Received Yes❑ No❑
DESCRIBE WORK Shorelines/Flood Hazard Plans Required❑
8• 'RE C.. �Ak� ' .T.E(Z_ -Pt Pi V,4 Yes Not Applic.0 Received 0
VALUATION I SOD
UTILITIES SOURCE GAS ELECTRIC WATER SEWAGE Ownership FEES COLLECTED
9 PUBLIC 0 SEPTIC 0
PRIVATE❑ SEWER❑ Public 0 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 Building
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 Plumbing
SIGNATURE OF 4') . DATEMech. A-t2 APPLICATION - S—ifJ'
OWNER OR AGENT �A�
SPECIAL APPROVALS SPECIAL CONDITIONS:(SEE REVERSE SIDE FOR NOTICE)
�� Plan Check
PRELIM. FINAL DATE 12_1 R k-Fl
Env.Health
SEPA
Planning Modular/
MFG.Home
Fire 12-
Prevent.
Prevent. v
Engineer Other(Specify) W
J
Utilities
' TOTAL $ 1-2•_
SEPA
WHEN MACHINE VALIDATED IN THIS SPACE,
Plans PERMIT IS NONTRANSFERABLE THIS BECOMES A PERMIT.
Exam. PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED ((��
Teching I`ll- Ya.5/65 IN 180 DAYS DATE4SiUEa 5 -8 3PERMITNa. 5 Z * 1 2.0 0 ¢dTAI