1983, 12-16 Permit: 83B-2573 Residence PLAN NUMBER 'APPLICATION/PERMIT PERMIT NUMBER
.- SPOKANE COUNTY — DEPARTMENT OF BUILDING &SAFETY b.-3 C.. 73
NORTH 811 JEFFERSON/SPOKANE,WASHINGTON 99260/(509)456-3675
APPLICANT: COMPLETE NUMBERED SPACES— PRESS HARD TO MAKE 3 COPIES
STREET ADDRESS PARCEL NO.
1. ca:, -710 , 1, Jv ?)�."r- . -I - ..2— e.7
LOT BLOCK SUBQ�NISIQN LEGAL DESCRIPTION:
3. Off. ou 1 C. Wige/%,,,7A�PHONE
MAILING DDRE I�,� `J 7��p Actual Set Backs in Feet to:ca- �_,
7, i`i 1?' �TV=� _ rf/ ?- North 3c.,--- 'South W [East I West
4• CONTR�_CTQR� LICENSE EXPIRES PHONE Sized, I0 , Zone ClassificationCommeaal❑
ADDRESS `s ZIP Type Cont. Occupancy .-7r17---
Sprinklered
❑Yes ❑No ❑Req'd.
DESIGNER ONE s 7� New Const.Valu n! /Remodeled Valuation Total Bldg.Floor Area
5. IG�It.I AI.ui GrGJ� .,� "� F'1
ADD SS C / Mai F)a9r Uppflr � Garagel forage Greenhouse
CHANGE OF USE FROM TO I Cover Deck Uncv.Deck Fin.'�asement Unfin. ase ent
No.BathsNo. No.Fin. ooms No.Dwellings
TYPE N ❑ ALT. ❑ AD'N. ❑ RPL. ❑ MVE. I
7• OF ❑ OTHER V
WORK BLD. ❑ PLMB. ❑ MECH. ❑ M.H. ❑ POOL Certifi.of Exempt. Required Yes❑ No❑ Number
or Variance Received Yes No El
DESGRIBORK c!Z {{ Shorelines/Flood Hazard Plans Required
8• +i I� / Yes Not Applic.❑ Received,
VALUATION SOURCE GAS / EL CE TRIC WATER/ SEPTIC Ownership FEES COLLECTED
9. UTILITIES PPUBLIC
RIVATE❑ SEWER❑ 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 n . The granting of a permit does not presume to give au-
thority to violate or cancel th provisions of any other st to or local law regulating construction or the performance
of construction.SEE RE ' • SIDE FOR RE •k A RED I $11ECTIONS Plumbing
SIGNATURE OF APPLICATION +'„s
r
OWNER OR AGEN, a/ .� �` DATE /?"' S Mech.
SPECIAL APP�iOV' L• SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE) x.
�� Plan Check
PRELIM. •L ct�ATE
Env.Health . ` •
Planning C)b 4 v L 4 '"
104 h� ' �/ SEPA
Modular/
Fire MFG.Home >-
Prevent. n-
O
Engineer
e /�/� Other(Specify) v
`Z( t0.� J_ I
Utilities
TOTAL $
SEPA
Plans ' iZ/ PERMIT IS NONTRANSFERABLE WHEN MACHINE VALIDATED IN THIS SPACE,
I THIS BECOMES A PERMIT.
Exam. V1, 1.
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
Belling 17 A IN 180 DAYS _
DATE I4SI D 1 6 83 PERMIT 41:5 7.3 z *4 4 8.0 0 O AL
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