1983, 03-28 Permit: 83A-2312 MHPLAN NUMBER
APPLICATION/PERMIT
SPOKANE COUNTY — DEPARTMENT OF BUILDING & SAFETY
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
A
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
STREET ADDRESS
1. E,-111\ i1 A
LOT
2.
BLOCK
SUBDIVISION
OWNER
3. A"STN IQ E. L+erw5
MAILING ADDRESS
-• 111\ ST*'
PHONE
PHONE
PARCEL NO.
245- i - .1- tG
LEGAL DESCRIPTION: E. ko' O g [ O r Z4 A+-` Boz %
f✓%1P1 RE Orr5. "z -"O
4. ADDRESS
CONTRACTOR `_
1�ATv1•loME X11 1Z•
LICENSE EXPIRES
DESIGNER
5.
ADDRESS
CHANGE OF USE FROM
•
ZIP
Ck
PHONE
ZIP
PHONE
ZIP
TO
TYPE ❑ NEW ❑ ALT. ❑ AD' N. E/RPL. ❑ MVE.
7. OF WORK ❑ BLD. ❑ PLMB. ❑ MECH. V� M.H. ❑ POOL ❑ OTHER
Actual Set Backs in Feet to:
North 34.. ` (South ZS
East -51
Size of Parcel
'70 ty ;.7?
Type Const.
`�N
Occupancy
-3
Cont. Valuation
Z6, a
West
Zone Classification
cLKI A.
Residential e
Commercial 0
Spr nklered
❑Yes ❑No ❑Req'd.
Remode ed Valuation
Main Floor
Upper Floors IGarage/Storage
(over Deck
No. Baths
Certifi. of Exempt.
or Variance
Uncv. Deck
No. Floors
DESCRIBE WORK
8. N6.UE y.1t0c
VALUATION SOURCEO
9 UTIF
LITIES
GAS
ELECTRIC
WATER SEWAC
PUBLIC SEPTIC WATER/ SEWAH
PRIVATE 0 SEWER 0
Total Bldg. Floor Area
Greenhouse
Fin. Basement
No. Fin. Rooms
Required Yes❑ NoK
Received Yes ❑ No ❑
Shorelines/Flood Hazard
Yes❑ NotApplic. 0
Ownership
Public 0 Private Er
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 FOR REQUIR) INSPECTIONS
SIGNATURE OF
OWNER OR AGENT
APPLICArTp
DATE _
SPECIAL APPROVALS
PRELIM. FINAL DATE
Env. Health
Planning
SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
Fire
Prevent.
Engineer
fr
Utilities
SEPA
Plans
Exam.
Building
Tech.
3
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 $ { • )
PERMIT NUMBER
83A- - \
07* *50.00
`*50006
A *0.00
231.1-2
03-28-83
L 6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
33 6 • p z
DATE 111172 8 - 8 3
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