1983, 09-22 Permit: 83A-9377 Insert PLAN NUMBER APPLICATION/PERMIT PERMIT NUMBER
SPOKANE COUNTY — DEPARTMENT OF BUILDING &SAFETY ' 7? 77
NORTH 811 JEFFERSON /SPOKANE,WASHINGTON 99260/(509)456-3675
- 1 APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
STREET ADDRESS , I PARCEL PFO.
1. • aCoD6a t�L?I i� r
LOT BLOCK SUBDIVISION LEGAL DESCRIPTION:
2.
OWNER I P�,IONjc -zo�4.PHONE
3.
MAILING r•ADI�ADDRESS /i Kq+NI; A If ' P 2 North Set Backs in Feet
East I West
CO T I LICENSE EXPIRES HONE I• Size of Parcel Zone Classification Residential❑
� j Commercial❑
4. ADDRESS ZIP Type Const. Occupancy Sprinklered
❑Yes 0N ❑Req'd.
DESIGNER PHONE New Const.Valuation Remodeled Valuation Total Bldg.Floor Area , u * w c C.
5. ADDRESS ZIP Main Floor Upper Floors 'Garage/Storage Greenhouse - y % /
CHANGE OF USE FROM TO Cover Deck Uncv.Deck Fin.Basement Unfin.Basement
6.
No.Baths No.Floors No.Fin.Rooms No.Dwellings
TYPE ..5t1(EW 0 ALT. 0 AAD'N. ❑ RPL. ❑ MVE.
7. OF
WORK ❑ BLD. 0 PLMB....E3 MECH. ❑ M.H. ❑ POOL ❑ OTHER Certifi.of Exempt. Required Yes No El Number
or Variance Received Yes Non
8. DESCR act /r 1,4 St� Seesr❑elinesNotApplic.0 Plansard Required 0
Received ❑
VALUATION SOURCE \v� GAS ELECTRIC WATER SEWAGE Ownership FEES COLLECTED
9OF
UTILITIES PUBLIC❑ SEPTIC❑
PRIVATE❑ SEWER CI Public❑Private❑
u 1
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 REVERS SIDE FOR REQUIRED INSPECTIONS Plumbing
SIGNATURE OF �� APPLICATION
OWNER OR AGENT DATE I— •2 z'B',3 Mech. '
SPECIAL APPROVALS SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PRELIM. FINAL DATE Plan Check
E
Env.Health
SEPA
Planning
Modular/
Fire MFG.Home a
Prevent.
O
Engineer Other(Specify) _ _ W
J_
Utilities LL
_ 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 �}
Building �/ I N 180 DAYS DATE ISSUED 7 PERMIT NO. �` z * O` O COAL
Tech. (✓//