1983, 04-12 Permit: 83A-2853 Insert PLAN NUMBER APPLICATION/PERMIT PERMIT NUMBER
01 SPOKANE COUNTY — DEPARTMENT OF BUILDING &SAFETY `
NORTH 811 JEFFERSON/SPOKANE,WAStNINGTON 99260/(509)456-3675
APPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 3 COPIES
STREET ADDRESS PARCEL NO.
1. 5 � 7� ' Cg-65'.-1-
j-r QfZ .
LOT BLOCK SUBDIVISION LEGAL DESCRIPTION:
2.
e
OWNER P ON PHONE /i * * i ' i l (;
3. Nt�i - %,160,..5--T' - Z%Q �}
MING 172-1
72 1S _ / \ -r Z - -7 NorActualth
Set Backs in Feet to:
South East `West A * `/
coni TO `Y/ LICENSE EXPIRES F(1-1NcE Size of Parcel II Zone Classification Residential❑
6. Commercial❑ 5 '
4. L 1i
ADD ESS ZIP Type Const. Occupancy Sprinklered
❑Yes ❑No ❑Req'd. V (L— 1 '— J
DESIGNER PHONE New Const.Valuation Remodeled Valuation Total Bldg.Floor Area __ 6, (J- 7 0
5. ADDRESS ZIP Main Floor Upper Floors Garage/Storage Greenhouse -
CHANGE OF USE FROM TO Cover Deck Uncv.Deck Fin.Basement Unf in.Basement
6. No.Baths No.Floors No.Fin.Rooms No.Dwellings
7 TOFPE /JEW ❑ ALT. 10 Ay'N. 10 RPL. ❑ MVE. ❑ OTHER
WORK ❑ BLD. ❑ PLMB. C�`MECH. ❑ M.H. ❑ POOL Certifi.of Exempt. Required Yes No❑ Number
or Variance Received Yes❑ No❑
8. DESCRIBE WORK \ i Shorelines/Flood Hazard Plans Required❑
r_VtYin' (, Yes❑ Not Applic.CI Plans
❑
VALUATION SOURCE GAS ELECTRIC WATER P C EOwnership FEES COLLECTED
9. OF
LITIES SEPTIC
PRIVATE
El SEWER El 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 nAPPLICATION
OWNER OR AGENT r DATE t 1�
S
3. r` ,, mech. '70(
SPECIAL APPROVALS SPECIAL CONDITIONS: E REVERSE SIDE FOR NOTICE)
PRELIM. FINAL DATE Plan Check
Env.Health
SEPA
Planning Modular/
Fire MFG.Home a
Prevent. p
Other(Specify) V
Engineer yl
J
LL
Utilities j /'p'
TOTAL $ G..—t!
SEPA
MACHINE
Plans PERMIT IS NONTRANSFERABLE HEIS BECOMES A PERM TTED IN THIS SPACE,
Exam. d' PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED n 4 1 o
Tech.Building Will �, IN 180 DAYS DATE iSSUED1 o PERMIT OR
z * O. O O�O AL
IIPP I