1983, 08-22 Permit: 83A-8000 ResidencePLAN NUMBER
APPIJICATION/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
STREET ADDRESS , II��.,�JJ
1. � � E) W 007tzj F
BLOCK SUBDIV
LOT
2. 7
2
ION
PARCEL NO.%n
rs-r
OWNER
3 �(C: �4V►�� c
MAILING ADDRESS
l2-'
CONT AC
4. ADDRESS
Mo o
}HONE
HONE
LEGAL DESCRIPTION:
ZIP
Actual Set Backs in Feet to:
North 2 !South /i
LICENSE EXPIRES
PHONE
Size of Parcel
11 East _✓ I West
Zone Classification
`, �' Sprinklered✓✓``
❑Yes ❑No ❑Req'd.
ZIP
5.
DESIGNER
PHONE
Type Co s�t. QcCupa cy
New Const. Valuation �� Remodeled Valuation
Residential
Commercial ❑
ADDRESS
ZIP
CHANGE OF USE FROM
6.
TO
Main FI1-c---)
Upper Floors
Uncvk
Total Bldg. Floor Area
Cover Deck
Garage lS or ge
Greenhouse
Fin. Baseme/
Unfin. Basement
TYPE jzr-W ❑ ALT. ❑ AD' N. ❑ RPL. ❑ MVE.
7. OF
WORK BLD. ❑ PLMB. ❑ MECH. ❑ M.H. E POOL
C IB OR
8. DESWwI r I�/
9.
VALUATION SOURCE G
UTILITIES
❑ OTHER
No. Baths
No. Floors
No. Fin ooms
No. Dwellings
Certifi. of Exempt.
or Variance
Required
Received
Yes No❑
Yes❑ No❑
Number
Shorelines/Flood Hazard
Yes L: NotApplic.
ELECTRIC
WATER_,
PRIVATE ❑
SEWAGE
SEPTIC
SEWER =
Ownership
Public E: Private2
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
SIGNATURE OF T APPLICATION
OWNER OR AGENT N. / . & k. DATE ?
Plans Require'
Received F'
SPECIAL APPROVALS
PRELIM.
.� FINAL DATE
ey20-2
Env. Health
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
exA
9.12-v
SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
7
( 3.b I ( CASs tic 171/06
PERMIT IS NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
FEES COLLECTED
Building
Plumbing
Mech.
Plan Check
SEPA
Modular/
MFG. Home
Other (Specify)
TOTAL $
PERMIT NUMBER
Soca
n2* *424.00
*424.006
A *0.00 0
794,02
08-18-83
6.479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATE I juiD2 2 - 8 3
PERMIT`NO.`^O z *4 2 40 0lo-AL
102-
77
I,
I
01: i
0: