1983, 06-02 Permit: 83A-4731 AC PLAN NUMBER APPLICATION/PERMIT PERMIT NUMBER
SPOKANE COUNTY - DEPARTMENT OF BUILDING &SAFETY g93/k — 473 I
NORTH 811 JEFFERSON/SPOKANE,WASHINGTON 99260/(509)456-3675
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
STREET ADDRESS PARCEL NO.
1. M 9/,'"///1//,&=-_--,,e 5/7X )41-2)
LOT BLOCK SUBDIVISION LEGAL DESCRIPTION:
2.
3. OWNER /-- --,e./ LA/,. /‹. PHONE 7O ���
MAILING ADDRESS ZIP Actual Set Backs in Feet to:
.A/ f/..5-//4////t";<5/ -..v _ 99 ze North ISouth East I West
CONTRACTOR LICENSE EXPIRES PHONE Size of Parcel Zone Classification Residential❑
4:LSIA1.'✓ L/iCAY',QC�dt `/ G -/,--.1 , 7 -/7// Commercial❑ J , .,
ADDDJ1ESS ,L ZIP C Type Const. Occupancy Sprinklered
F
` '. Ze 7 -. 7/ 2- ❑Yes ❑No ❑Req'd.
DESIGNER PHONE New Const.Valuation Remodeled Valuation Total Bldg.Floor Area i,
5. ADDRESS ZIP Main Floor Upper Floors Garage/Storage Greenhouse
i_)- li C- ' J
CHANGE OF USE FROM TO Cover Deck Uncv.Deck Fin.Basement Unf in.Basement
6. `l '
No.Baths No.Floors No.Fin.Rooms No.Dwellings
7• TYPE 0 NEW 0 ALT. . /AD'N. 0 RPL. ❑ MVE. ❑ OTHER
WORK 0 BLD. ❑ PLMB.C?MECiH. ❑ M.H. ❑ POOL Certifi.of Exempt. Required Yes No❑ Number
or Variance Received Yes No❑
8 DESCRIBE WORK mess Flood icPlans
• /1A/_47,-;%/-e- //<' CeA/ /yrA 44 - L ti/A/e', S/3' ' Yes pl .U Received ❑
VALUATION SOURCE GAS ELECTRIC WATER SEWAGE PUBLIC❑ SEPTIC❑ Ownership FEES COLLECTED
9 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 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 ij . �1��` APPLICATION 31—
'/ y
OWNER OR AGENT /7" DATE .S �'/` 3 Moon T L
SPECIAL APPROVALS SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PRELIM. FINAL DATE Plan Check
Env.Health ��
2/2- moi// SEPA
Planning
Modular/
MFG.Home
Fire
Prevent. a
O
Other(Specify) V
Engineer IW
_.I
s fr
Utilities /9:ee,
TOTAL $
SEPA
•
MACHINE
Plans PERMIT IS NONTRANSFERABLE HEIS BECOMES A PERM TTED IN THIS SPACE,
Exam. PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
Buil ing (OJ IN 180 DAYS ��jj qq ��77 �7 9�"
3 ., `�, DATE9SSUEDO 2 _8 3 PERMIT`NO. 3, 1 5 * 1 4. 0 0 io AL