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1983, 03-17 Permit: 83A-1947 MHPLAN NUMBER APPLICATION/PERMIT PERMITNUMBER 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 ADDRESS PARCEL NO. -7�. tJ 01 �� LOT 2. I BLOCK Z� SUBDIVISION � I� LEGAL DESCR TION: j I © r�yy� �'] I (/ry d r �% / / OWNER PHONE PHONE'" 3. S'r MAILI AD ESS –5-60) IP ActualSet Backs in Feet i ` IG �Y ? D 1 SouthEast West 10 CONTRACTOR LICENSE EXPIRES HONE Size of Parceln, Classification Residential 21, 4. K -3e? 01�1 K1_" I Commercial ❑ A DRES ZIP Type Const. Occupy Sprinklered ❑Yes ❑No ❑Req'd. iv 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. TYPE NEW El ALT. ElAD'N. ❑ RPS. ElMVE. No. Baths No. Floors No. Fin. Rooms No. Dwelling 7. OFs ❑OTHER CertifLofExempt. -7 Required Y No❑ Number WORK El BLD. 1:1 PLMB. ❑ MECH. M.H. ❑ POOL orVariance Received Y No F] 8 DESC IB�� OORK 2 Shorelines/ Flood Hazard, Plans Required ❑ TT Yes❑ Not Ap lic. ` Received ❑ VALUATION 9• 10 SOOUFC GAS ELECTRIC PUBLICR SEPT C E Ownership FEES COLLECTED 625)0 UTILITIES PRIVATE ❑ SEWER ❑ Public ❑ Private I hereby certify that I have read and examined this application and have read the "NOTICE" provisions includedon 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 I APPLICATION OWNER OR AGENT ��'� DATE �� a Mech. ��n�*� -. c?�41—y- SPECIAL APPROVALS SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE) PRELIM. FINAL DATE Plan Check Env. Health Z_y SEPA Planning Modular/ Fire - MFG. Home V Prevent. CLC Engineer /1 Other (Specify) C LL Utilities LL TOTAL $ 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 Building Tech. i / IN 180 DAYS 1 DATE ED PERMITLt 4.7 z *5 0. 0.010 ..3 PERMIT NO. Spokane County Planning Department ShQrt Plat Exemption Certificate 1. WAS THIS PARCEL SEGREGATED BEFORE MARCH 13. 1978, OR WAS APPLICATION TO SEGREGATE MADE BEFORE MARCH 13, 1978 ?YES NO (exempt under section 3.365 of Short Plat Ordinance) 2. IS THIS PARCEL 10 ACRES IN SIZE OR LARGER ? YES � NO (exempt under section 3.3E of Short Plat Ordinance) 3. WILL THIS PARCEL BE USED FOR A PUBLIC UTILITY FACILITY ? YES 'NO (exempt under section 3.384 of Short Plat Ordinance) -4. IS THIS SEGREGATION BEING ACCOMPLISHED TO EFFECT A MINOR BOUNDARY OR PROPERTY LINE ADJUSTMENT, BUT NOT CREATING ANY NEW LOTS OR CAUSING OTHER LOTS TO FALL BELOW MINIMUM ZONING STANDARDS FOR SIZE SHAPE OR FRONTAGE, OR AFFECTING ROAD ACCESS TO ANY OTHER LOTS ? YES NO (exempt under section 3.3H of Short Plat Ordinance) 5. IS THIS PARCEL ZONED RESIDENTIAL OFFICE. LOCAL BUSINESS, COMMERCIAL. FREEWAY COMMERCIAL, INDUSTRIAL OR MANUFACTURING ? YES NO (exempt under section 3.3B4 of Short Plat Ordinance) e000rnrrn nv. DATE: �' ?�3 I hereby certify the a wers I have offered in connection with obtaining this exemption are true.......... APPLICANT'S SIGNATURE: �„ _�AnrJ`��� DATE bAl�l .v. r I f ,I Ht NU,I U1Nl, N 121 )Lf f LHSON S{HEE1 SPOKAW WASItING1ON 992b0 PItONt 456-220S