1983, 06-23 Permit: 83A-5676 Repair Fire Damage PLAN NUMBER APPLICATION/PERMIT PERMIT NUMBER
SPOKANE COUNTY - DEPARTMENT OF BUILDING &SAFETY SS SI '56-7(,o
NORTH 811 JEFFERSON/SPOKANE,WASKirNYGTOiJ 99260/(509)456-3675
c. APPLICANT:COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
STREET ADDRESS PARCEL NO. C c' v r. 1 C 0
1. S- <<05 Le,-)cap vaw>v - s --oa
LOT BLOCK SUBDIVISION LEGAL DESCRIPTION:
2. 4 eq., WOdDt,. flmo * -
OWNER PHONE PHONE 5 6 / y
NR,1/41 kAiiLLilAINASot.
MAILING ADDRESS ZIP Actual Set Backs in Feet to: ExTt"3Cf 6 — -- ''
5.l tos WCO�(...A w N Qc,c-- -:� North [South East I f'. L
West
CONTRACTOR LICENSE EXPIRES PHONE Size of Parcel Zone Classification �' I1
tt•tZ• 5cat5tce INC,. S3S-BCommercial❑
P,n( — Residentially
4. ADDRESS t� ZIP__ Type Const. Occupancy Sprinklered
IJ..7Z0 COO " -D_ arn) 2,..- ❑Yes 0 N ❑Req'd.
DESIGNER PHONE New Const.Valuation Remodeled Valuation Total Bldg.Floor Area
5. .?.O.OC/C)
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.DwellingsTYPE 0 NfiW O ALT. 0 AD'N. 01/1PL. D MVE.
7 WORK LD. ❑ PLMB. ❑ MECH. ❑ M.H. ❑ POOL ❑ OTHER Certifi.of Exempt. Required Yes❑ No❑ Number
or Variance Received Yes No
�
7DESCRIBE WORK Shorelines/Flood Hazard Plans Required'❑
8' t?EMIR. • rLast)A t'h,AC Yes 0 Not Applic.0 Received 0
VALUATION SOURCE GAS ELECTRIC WATER SEWAGE Ownership / FEES COLLECTED
9. ` `tze UTILITIES PUBLIC❑ SEPTIC❑
PRIVATE 0 SEWER❑ Public 0 Private Cr
I hereby certit7 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 ' 'ay`�U
work will be complied with whether specified - ; • or not. The granting of a permit does not presume to give au-
thority to violate or cancel the •rovisions of ay y othe •tate or local law regulating construction or the performance
of construction.SEE REVEE-.i" FOR R v•UIRE. NS•ECTIONS 9 Plumbing
SIGNATURE OFOWNER OR AGEN I _ / �I DATECATN �
Mech.
SPECIAL APPROVALS SPECIAL CONDITIONS:(SEE REVERSE SIDE FOR NOTICE)
Plan Check
PRELIM. FINAL DATE
Env.Health
SEPA
Planning
Modular/
Fire MFG.Home !
Prevent. d
O
Engineer Other(Specify) V
W
J_
Utilities I Vi,Oe
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
BuTech.ng af9-<Q43 IN 180 DAYS `a 3 -g 3 it,d.7.6 z * 15 6.0 0 �*AL
Tech. DATE E PERMIT