1983, 06-03 Permit: 83A-4812 Residence PLAN NUMBER APPLICATION/PERMIT PERMIT NUMBER
q'3 `-15\ ., SPOKANE COUNTY — DEPARTMENT OF BUILDING &SAFETY 83 A tt [Z_
CI NORTH 811 JEFFERSON /SPOKA E, ,fASHINGTON 99260/(509)456-3675
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
STREET ADDRESS PARCEL NO. q
1. E. i3Coi •
22 J 4 I - t I'76
LOT BLOCK SUBDIVISION LEGAL DESCRIPTION:
2. (L. 57 78—001 P -la 4LexikA Gokt.E.labIDt,3
OWNER PHONE PHONE A94:0-- c-
MAILING� ADDRESS-t 9 D 4 StiA tl n p� 41C\ZIP �3 North SetBackss in(Feet to:h
Vv I�C�� North L South East I West 1 0 //
CONTRACTOR LICENSE EXPIRES PHONE Size of Parcel Zone Classification Residential Cx
Zo •x ' AG Commercial❑
a. 69 - C®tz- .
ADDRESS ZIP Type tw Const. ^ Sprinklered
`V'o' ❑R d. * - .- `� t CnN. ❑Yes ❑No �,
DESIGNER PHONE New Const.Valuation / Remodeled Valuation Total Bldg.Floor Area r n I IJ CJ
LI
5' g1RQA � 1� Tp _ Z s 1(Da® 9ain F�r WI�U per Floors Garage/Storage ' Greenhouse
* " c n
L Ok 3�+v1r't5 -r 11.51 — '' `� i
CHANGE OF USE FROM TO Cover Deck Uncv.Deck I Fin.Basement Unf in.Basement
4KA/ No.Baths No.Floors No.Fin.Rooms No.Dwellings E r ; nTYPE 0 ALT. 0 AD'N. 0 RPL. 0 MVE. 1 1 5 t '
7• OF 0 OTHER /
BLD. 0 PLMB. 0 MECH. 0 M.H. 0 POOL Certifi.of Exempt. Required YesE Nod Number
or Variance Received Yes No❑ / 1
WORK
DESCRIBE WORK w Shorelines/Flood Hazard ,..... Plans Required
8. 'Si ,�� T� ' 0.^ (ILA Yes Not Applic.P/ Received
H
VALUATION SOURCE GAS LECTRIC WATERR./..-- SEWAGE/ Ownership /' FEES COLLECTED
PUBLIC C3' SEPTICS
9• UTILLIITIES PRIVATE❑ SEWER❑ Public❑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 Z1
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 Plumbing
SIGNATURE OFr � C.
` �J APPLICATION �y Mech.
OWNER OR AGENT C � Q SZ� S--I 0'- DATE d
(
' SPECIAL APPROVALS SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
Plan Check
PRELIM. FINAL DATE I
Env.Health /4/1459(P459(P0 �
SEPA I
Planning Modular/
MFG.Home .�.
Fire a
Prevent.
Engineer Other(Specify) WPita,/ qt 1
J
Utilities �
TOTAL $ ____l_
SEPA
WHEN MACHINE VALIDATED IN THIS SPACE,
11/4 Plans ��}�'/f PERMIT IS NONTRANSFERABLE THIS BECOMES A PERMIT.
'"' "dam7 PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
Budding IN 180 DAYS DATE�S6ED O 1� —�'
Tech. PERMIT 4C13 L 2z * 2 91.0 O,,b AL
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