1983, 04-22 Permit: 83A-3211 Pool PLAN NUMBER APPLICATION/PERMIT PERMIT NUMBER
ei 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
STREET ADDRESS PARCEL NO. *
1. -s I ZD ��ov t✓s'S� 42-054 4 —I 7 3 �r�cv��
L BLOCK SUBDIVISION LEGAL DESCRIPTION: 7-r
2. ., Cot (2- „Ka 2$` vT /of /3teKc '7'4e ‘,/,4k
OWWIU'�lrPHONE PHONE (�
3.� ud`l a` Ku✓eh 804/A/6 �22�3/05 5 Foy �BLs „ d ,� I i17 a , ( vw ,
MAILING ADDRESS ZIP Actual Set Backs in Feet to:
5, l 2-0, tAJCC7 7 North 5' 'South East 12.t I West
CO TRACTOR LICENSE EXPIRES PHONE Si of I rcelone Classifi tion Residential
7 19' 1.0, . Commercial❑
4. ADDRESS ZIP Type co st. Occncy ” '��`� Sprinklered
u1.� ❑Yes 0N ❑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 Unf in.Basement
6.
�,1 No.Barns No.Floors No.Fin.Rooms No.Dwellings
TYPE ¢ANEW ❑ ALT. El AD'N. ❑ RPL. El MVE.
7. OF , \
❑ BLD. ❑ PLMB. ❑ MECH. ❑ M.H. ❑ OTHER Certifi.of Exempt. Required Yes No Number
WORK or Variance Received Yes No
DESCRIBE OR A Shorelines/Flood Hazard Plans Required CI8. I ]L/11 ply Yes❑ Not Applic.0 Received 0
VALUATION SOURCE GAS ELECTRIC WATER SEWAGEt
LI PUBLIC y/ SEPTIC Ownership FEES COLLECTED
9. UTILITIES PRIVATrD SEWE ❑ Public 0 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 ,/ APPLICATION
OWNER OR AGENT `�L' e i G�a� DATE 4,,
83 Mech. t
SPECIAL APPROVALS SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
•
PRELIM. FINAL DATE Plan Check
Env.Health
/Il) 'i aI SEPA
Planning Modular/
MFG.Home ).. i
Fire a-
Prevent. 0
Engineer Other(Specify) W
J_
Utilities LI
TOTAL $ ,
SEPA i
PERMIT IS NONTRANSFERABLE WHEN MACHINE VALIDATED IN THIS SPACE,
Plans THIS BECOMES A PERMIT.
Exam. PERMIT IS NULL AND VOID IF WORK HAS.NOT COMMENCED (� Q 2 1
Tech. `� '�/j IN 180 DAYS DATEYSBIIEt PERMIT NO.1, ` z * 2 5 0 0 TOYRL
0-
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