1983, 08-09 Permit: 83A-7505 ACPLAN NUMBER APPLICATION /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
STREETADDRESS PARCEL NO.
LOT BLOCK SUBDIVISION LEGAL DESCRIPTION:
2.
OWNEH
PHONE ` /
PHONE
Z Al „I
(;����
3.
MAILING ADDRESS
ZI
Actual Set Backs in Feet to:
North South East
West
CONTRACTOR
LICENSE EXPIRES
PHONE
Size of Parcel
Zone Classification
1
Residential ❑
4. BAN
1711
1
1
Commercial ❑
ADDREss BOX 4336
1' U
ZIP99202
Type Const. Occupancy
Sprinklered
Dyes ❑No ❑Req'd.
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 ❑ ALT. D' N. ❑ RPL. ❑ MVE.
No. Baths No.
Floors
No. Fin. Rooms
No. Dwellings
,K
!• W ❑'BLD. ❑ PLMB. �'MECH. ❑ M.H. ❑ POOL 13 OTHER
WORK
�ifi.ofExempt.
Required
Yes❑ No❑
Number
or Variance
Received
Yes ❑ No ❑
DESCRIBE WORK
8• `
Shorelines/ Flood Hazard
Plans Required ❑
"7�/j/
Yes❑ Not Applic. ❑
Received ❑
VALUATION I
9
SOOURCE
GAS
ELECTRIC
PUBLIWATC ❑
SEPTISEWAGE
U"nership
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-
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 APPLICATION
14 tz 5"
OWNER OR AGENT -' DATE
Mech.
SPECIAL APPROVALS
SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PRELIM. FINAL DATE
Env. Health
�// /
��/ ��� ��i'V'.�l1 tT��,� �-�� � ':Z%�
Plan Check
SEPA
Planning
Modular/
_.
MFG. Home
Prevent.
Engineer
Utilities
SEPA
Plans PERMIT IS NONTRANSFERABLE
Exam. PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
T-11 ng IN 180 DAYS
Other (Specify)
TOTAL $ -L-=��
PE717T M7�
� 4u� 5� 1
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
08'0'9-83
DATE ISSUED PERMIT O. z
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