1983, 07-20 Permit: 83A-6747 AdditionPLAN NUMBER
c-
APPLICATION/PERMIT
SPOKANE COUNTY — DEPARTMENT OF BUILDING & SAFETY
NORTH 811 JEFFERSON / SPOKANE; /ASH'NGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
STREET ADDRESS
1. :3
2.
LOT BjjJC SUBDIVISION �w A
OWNER/1,\1
3 6113
• MAILING ADDRESS
4-41? 3'
CONpRA rz
4. ADDRESS
LICENSE EXPIRES
DESIGNER
5.
ADDRESS
PHONE
PHONE
ZIP
CHANGE OF USE FROM
TYPE w
BLD
PHONE
ZIP
TO
❑ ALT. 12 'N. 1=1RPL. ❑ MVE.
7 OF ❑OTHER
WORK ❑ PLMB. ❑ MECH. ❑ M.H. ❑ POOL
PARCEL NO.
235-32-, - • moi 1
LEGAL DESCRIPTION:
L71 Lr 10 (c c. N. 51)
Actual Set Backs in Feet to: l
North 'South I East I West 4-0
Size0 rex.'
r;uClassifloation
13.
Residential �l
Commercial ❑
Type.
3y
New Const. Valuation
I CO
DE IB `QRKMC d
8. rj
VALUATION SOOOFCE GAS ELECTRIC pUBLIE72 SEPTIAC '•
9• UTILITIES PRIVATES ❑ SEWER ❑
Main F
Sprinklered
❑Yes ❑No Req 'd.
Remode ed Valuation
Upper Floors
cover Deck
No. Baths
Total Bldg. Floor Area
Garage/Storage
No. Floors
Certifi. of Exempt.
or Variance
Greenhouse
Fin. Basement
No. Fin. Rooms
Required Yes No❑
Received Yes No❑
Shorelines/Flood Hazard
Yes❑ Not Applic. ❑
Ownership
Public 0 Private 0
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 FQR REQUIRED INSPECTIONS
SIGNATURE OF ' 4; '' 7 } APPLICATION C—`�,
OWNER OR AGENT / / %� DATE
SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
SPECIAL APPROVALS
PRELIM. FINAL DATE
Env. Health
tom 1ItS
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
PERMIT IS NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
Unfin. Basement
No. Dwellings
Number
Required 0
Received 0
FEES COLLECTED
Building
Plumbing
Mech.
Plan Check
SEPA
Modular/
MFG. Home
Other (Specify)
TOTAL $
P MTNUMBER
Pt .a5 -7
02* *54.00
59812
06-29-83
64.79.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
fl? -20-83
DATEISSUED
67475
PERMIT NO.
*5400 a�
TOTAL
1.
i
12044
1