1983, 08-12 Permit: 83A-7755 Reroof, RemodelPLAN NUMBER
APPLICATION/PERMIT
SPOKANE COUNTY — DEPARTMENT OV BUILDING & SAFETY
NORTH 811 JEFFERSON / SPOKANE, WA_HINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
STREET ADQfj)=SS
1 G—
LOT BLOCK
2.
SUBDIVISION
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OWNER
3. i.s �IO�621
PHONE
fv�ILINGefpgEoco 1:2_0
CQVT�re0t-
LICENSE EXPIRES
4. }t
• ADDREss
N [1 ,\ oN11--
5.
DESIGNER
ADDRESS
CHANGE OF USE FROM
PHONE
ZIP
7
PHONE
ZIP
TO
TYPE,OF_❑,NEW L�7'ALT. El AD' N. ❑ RPL. ❑ M•VE.
7.WORK �' 4/LD. ❑ PLMB. E MECH. 111 M.H. ❑ POOL El OTHER
PARCEL NO. 2,e3 Z3�
LEGAL DESCRIPTION: •
li 5
Actual Set Backs in Feet to: C '
North South [East
Size of
Type Const.
Occupancy
New Const. Valuation
Cover Deck
No. Baths
Certifi. of Exempt.
or Variance
West
ZIRCI_ - if'cation
Residential ❑
Commercial ri
Sprinklered
❑Yes ❑No Req 'd.
Remodeled Valuation
Total Bldg. Floor Area
No. Floors
Greenhouse
No. Fin. Rooms
Required Yes❑ No❑
Received Yes No C]
DES
8. i
9. v�L/OV
SOURCE
UTILLIITIES
PSI00 or -
GAS
ELECTRIC
Sits,
WATER /
PUBLIC 3
PRIVATE ❑
SEWAGE
SEPTIC f
SEWER 0
Shorelines/Flood Hazard
Yes❑ Not Applic. C
Ownership
Public 0 Private
J 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 i DATEAPPLICATION b — /� — ;9-3
OWNER OR AGENT
SPECIAL APPROVALS SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
r7 25 )
PRELIM. FINAL DATE
Env. Health
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
Plans Required ❑
Received E
FEES COLLECTED
Building
Plumbing
Mech.
Plan Check
SEPA
Modular/
MFG. Home
Other (Specify)
TOTAL $
PERMI NUMBER .�
02-
34 0`
0 ct-s
1312.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATE'I
UE
2 — 8 3
PERMIT+N6.5' S Z
*3400 AL