1983, 05-12 Permit: 83A-3976 Duplex PLAN NUMBER - APPL UCI T I N/PERMITPERMIT NUMBER
P5 \1�- SPOKANE COUNTY — DEPARTMENT OF BUILDING &SAFETY bs A yi7Lo
(_) NORTH 811 JEFFERSON /SPOKANE,WASHINGTON 99260/(509)456-3675
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
STREET ADDRESS PARCEL NO.
1. E.101 Z i--Z3 S-P(2_41 N G 5 osc-.3 1(054-3- o164.
LOT BLOCK SUBDIVISION LEGAL DESCRIPTION: ''
2. i 3 7vJiAf2-OS '5(..),j. x%01 1.,oN
OWNER PHONE PHONE
3. C IaaeLCS r.. C AP-O ti6cz. Gi 3.,(0-5 3
MAILING ADDRESS ZIP Actual Set Backs in Feet to:
1(467 E, . t e.E ry �=t
-r q abG North Z.?1 (South 3S East i..a i I West \f '
CONTRACTOR LICENSE EXPIRES PHONE Size of Parcel Zone Classification Residential
i°NlM E qs X i�r� Ac.A.�.r3 Commercial 0
4. ADDRESS ZIP Type Const. Occupan y Sprinklered
SAIle., - --
.,� R-3 �-� ❑Yes ❑No ❑Req'd.
DESIGNER PHONEewConst.Valuation Remodeled Valuation Total Bldg.Floor Area
5. New
`-11 i?Col -z42_
ADDRESS ZIP Main Fl�r Upper Floors Garage/Storage Greenhouse
,crk
CHANGE OF USE FROM TO Cover Deck Uncv.Deck Fin.Basement Unf in.Basement
6.
64 No.Baths No.FloorstNo.E.Rooms No Z lings
TYPE Q EW ❑ ALT. ❑ AD'N. ❑ RPL. El MVE. Z � �'j
7. OF WORK BLD. ❑ PLMB. ❑ MECH. ❑ M.H. ❑ POOL 111 OTHER Certifi.of Exempt. Required Yes❑ ,No Number
or Variance Received Yes El No El
C Shorelines/Flood Hazard Plans Required /
8. ftE WORK Yes Not Applic.0 Received B"@'
VALUATION SOURCE GAS ELECTRIC WATER f7 /SEWAGE/ Ownership FEES COLLECTED
9 OF
UTILITIES PUBLIC SEPTIC
PRIVATE 0 SEWER 0 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 4t 2.co
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 REVERS SITE F F. • REQUIRED INSP• IONS Plumbing
SIGNATURE OF APPLICATI• /'.03
OWNER OR AGENT - 4.....‘" '_ —�/ - DATE : ` Mech.
SPECIAL APPROVALS SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE
PRELIM. FINAL DATE Plan Check
Env.Health
?Cad()
'- , SEPA
Planning
Modular/
Fire MFG.Home )-
0.
Prevent. 0
O
Engineer Other(Specify) v
J"�.�F�e�4�,2-. —I
ILI
Utilities
TOTAL $
SEPA
PERMIT IS NONTRANSFERABLE WHEN MACHINE VALIDATED IN THIS SPACE,
Plans 3� THIS BECOMES A PERMIT.
Exam. $-3 PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
Building - IN 180 DAYS n o
Tech.
3(7'3-
DATJS U ri 2 — r' PERMITAO.�. z L.LI ti "dud.
,
I�/ /41 — JI I, 1 a= -/cl-1
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