1983, 12-20 Permit: 83B-2678 ResidencePLAN NUMBER
APPLICATION/PERMIT
SPOKANE COUNTY - DEPARTMEVtI OF BUILDING & SAFETY
NORTH 811 JEFFERSON / SPOKANE, WAS4INGA3N 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
1.
2.
3
STREET ADDRESS
LOT
Co
OWNER
> lz-r S i i c
BLOCK
PARCEL NO.
SUBDIVISION
`ME t..GEtS ADD -ro QC-AziA
L'CSrJS":,
PHONE
PHONE
Ct2$-�16� t
541 t 504,
LEGAL DESCRIPTION:
MAILING ADDRESS
C. 14.1 t5
CONTRACTOR
4. SAsv.E
ADDRESS
satV.E
DESIGNER
5.
LICENSE EXPIRES
ADDRESS
CHANGE OF USE FROM
6.
7.OF
ZIP
G4i?57
PHONE
ZIP
PHONE
ZIP
TO
TYPE M5JEW ❑ ALT. ❑ AD' N.
WORK tgi BLD. ❑ PLMB. CI MECH.
❑ RPL.
❑ M.H.
❑ MVE.
O POOL
0 OTHER
Actual Set Backs in Feet to:
North 'South 'LJ, East -Z4j ( West
Residential'
Commercial ❑
Size of Parcel Zone Classification
(SC 140 aAA c;, la-,
Type Const.
Occupancy
tl 31 Al.
Sprinkiered
❑Yes ❑No ❑Req 'd.
tiew Const. Valuation
3,8012
Remodeled Valuation
Total Bldg. Floor Area
44O
Upper F cors
Garage/Storage
Greenhouse
Cover Deck
Uncv. Deck
10
Fin. Basement
Unfin. Basement
No. Baths
'Z
No. Floors
Certifi. of Exempt.
or Variance
No. Fiinn.. Rooms
Required Ye ❑ Not (
Received Yes ❑ No ❑
No. Dwellings
Number
DESCRIBE WORK
8.
VALUATION
9.
SOURCE
OF
UTILITIES
GAS
Shorelines/Flood Hazard
Yes Not Applic. ❑
ELECTRIC
WATER
PUBLIC
PRIVATE ❑
SEWAG
SEPTIC
SEWER ❑
Ownership
Public 0 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
work will be complied with whether specified herein •r not. The granting of a permit does not presume to give au-
thority to violate or cancel the prov'sions of th tate or local law regulating construction or the performance
of construction. SEE REVERSE • • : R Q ' • NS
SIGNATURE OF
OWNER OR AGENT
SPECIAL APPROVALS
PRELIM. FINAL DATE
APPLICATION — 2 `
DATE
Env. Health
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
Leo
PERMIT IS NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
Plans Required /
Received f9K
FEES COLLECTED
Building f-a�• z%
Plumbing
Mech.
Plan Check
SEPA
Modular/
MFG. Home
Other (Specify)
TOTAL
PERMIT NUMBER
& r2g761
02* *29600
*296006
A *000 8
193.72
11-22-83
2 6479,
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATEItS Et ° — 8' 3
PERMIT'NO. 8 z *2 9 6 0 O QOTAL
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