1983, 05-23 Permit: 83A-4355 Residence PLAN NUMBER • 4' . - APPL ICAT IOFB/1'ER M IT - PERMIT NUMBER
1 A 5'9 - SPOKANE COUNTY — DEPARTMENT OF BUILDING &SAFETY - li•- 7
, 4 NORTH 811 JEFFERSON/SPOKANE,WASHINGTON 99260/(509)456-3675
,
APPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 3 COPIES
•
STREET ADDRESS PARCEL NO.
1. i1 , Q_EeACcam" 2.54.1 -ao�LOT BLOCK s BDIVISLEGAL DESCRIPTION:
2. 2, R:yAfarXAl.-)-C' aOD ,bb
OWNER PHONE PHONE
MAILING ADDRESS ,.._ ZIP Actual Set Backs in Feet to:
Si C North 3 0 'South et S' East Z.'0 I West
CONTRACTOR LICENSE EXPIRES PHONE Size of Parcel Zone Classification Residential 6f/
4. `- _ OSx ns- j , e.—i Commercial 0
•
ADDRESS ZIP Type Const. Occu Sprinklered
LPN �.3 t y 1 ❑Yes 0 N ❑Req'd.
DESIGNER ., PHONE New Const.Valuation ` Reid Valuation ' Total Bldg.Floor Area
5. . 5-s-c-l-3_( -a 54:56Z' ty S*N
ADDRESS ZIP Main Floor_ Upper Floors Garage/Storage Greenhouse '
CHANGE OF USE FROM TO Cover Deck Uncv.Deck Fin.Basement Unf in.Basement
6. rze qi4
No.Baths No.Floors No.Fin.Rooms No.Dwellings
TYPE NE ❑ ALT. 0 AD'N. ❑ RPL. ❑ MVE. .,
7. OF ❑ OTHER ?J•5 Z.
WORK LD. LI PLMB. ❑ MECH. ❑ M.H. ❑ POOL Certifi.ofExempt. Required Yes No Number
or Variance ived Yes 0 No❑
DESCRIBE WORK (�,�YAK_ Shorelines/Flood Hazard Plans Required+!(:„..•
8. I tQC,f...G tAI'ik .S QJ( & Yes Not App ic. Received Vr
VALUATION SOURCE GAS ELECTRIC PUBLICO SEPTIC GE Ownership / FEES COLLECTED
9. UTILITIES PRIVATE❑ SEWER SEWAGE/
Public❑Private •�( ` 1 0
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 3`-i Z-. ;`\
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 i, `,
of construction.SEE REVERSE SIDE FOR REQU 'ED INSPECTIONS Plumbing
SIGNATURE OFAPPLICATI /a
OWNER OR AGENT (/ DATE Mech. C.
SPECIAL APPROVALS SPE.
AL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
Plan Check
PRELIM. FINAL DATE
nv.Health
NIA SEPA
Ianni ng
Modular/
Fire MFG.Home
Prevent. a
,ineer Other(Specify) i.Z (.tZeC i n Joi.W ok an) W
-aaicy 50
Utilities LL.
TOTAL $
SEPA
WHEN MACHINE VALIDATED IN THIS SPACE,
*Ins PERMIT IS NONTRANSFERABLE THIS BECOMES A PERMIT.
m. 144 PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED ,
Budding �J IN 180 DAYS l(��5j z 5 o 0 J
Tech site. DATE ISSUED 3 -8 3 PERMIT NOJ �' z * 3 5 4 O 0 TOTAL
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