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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 vl 0 1,5i 91' L t I .7 VEC 13812 - E STh L -or C Black al ,09 La ,0 N ge 26e_s n0011 E3 ' Tb Vela 34' r � 6 06: v N u, N°R Co /4 CFI S I 1 w57 E1471J — 17y`nvr �22-'-i47)