1983, 05-03 Permit: 83A-3586 Addition PLAN NUMBER APPLICATION/PERMIT PERMIT NUMBER
SPOKANE COUNTY — DEPARTMENT OF BUILDING &SAFETY __'3511E2_
' - NORTH 811 JEFFERSON/SPOKANE,WASHINGTON 99260/(509)456-3675
APPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 3 COPIES
STREET ADDRESS PARCEL NO.
1. - 1 1 1 2 -i i'f' I 54?_ "-' I P-54-
LOT BLOCK SUBDIVISIONLEGAL DESCRIPTION:
2. oPHONE N
3 PA, i., c Lrr\ibp< M i Ltdi K // '7-657
M LIN ADDRESS ZIP Actual Set Backs in Feet to: �^
. 1 I 1 --‘..-4,...— &.111 69 North (South .7O/ East I West
4 COT ) l ���5l� LICENSE EXPIRES :QI6 7-6 1 _ j�� SizeofPO Ix r 4- ZQne Classification Residential meal 0
ADDRESS- 1ri q'-c6. - 0 TY� Occupancy
Spri7nkl�ered
I. ❑Yes ❑No ❑Req a.
DESIGNER PHONE New Const.Valuation Remodeled Valuation Total Bldg.Floor Area
5. ADDRESS ZIP Main Flog, Upper Floors Garage/Storage Greenhouse A
6 CHANGE OF USE FROM TO Cove`Qeck Uncv.Deck Fin.Basement Uriin.Basg,�nent
TYPE ❑ EW ❑ ALT. ?AD'N. ❑ RPL. ❑ MVE. No.Baths No.Floors No.Fin.Rooms No.Dwellings
7• OF ❑ OTHER
WORK BLD. ❑ PLMB. ❑ MECH. ❑ M.H. ❑ POOL Certifi.of Exempt. Required Yes❑ No❑ Number
or Variance Received Yes❑ No❑
DES I E WORK ✓�r� Shorelines/Flood Hazard Plans Required
8. 6E i I c7 f•7e I` t� Yes❑ Not Applic.❑ Receivedd
VALUATION SOURCE I GAS , ELECTRIC WATER SEWAGF� Ownership FEES COLLECTED '
9•
UTILITIES SEPTI
RIVA�E❑ SEWER
O
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 Building Y�
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 REVE-rE SIDE FOR REQ IRED INSPECTIONS Plumbing
SIGNATURE OF if i
' r- DATE
OWNER OR AGENT A� S-3 ~�� Mech.
SPECIAL APPROVALS SPECIAL CONDITIONS: EE REVERSE SIDE FOR NOTICE)
PRELIM. FINAL DATE
.„91,...W. LIC NT I UN r\PRi 2"I 1903 Plan Check
Env.Health I ' I
" 'r�"4 Z- / SEPA
Planning Modular/
Fire MFG.Home a
Prevent. p
Engineer Other(Specify) W
J_
Utilities
TOTAL $ "
SEPA
PERMIT IS NONTRANSFERABLE WHEN MACHINE VALIDATED IN THIS SPACE,
Plans 5/?-)'
j, THIS BECOMES A PERMIT.
ern' K: PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
Building 5/ IN 180 DAYS (� 55 _(� 8 Q
Tech. t‘ DATEYSSUEDO 3 _ 3 PERMITla u.v z * 6 8. 0 0 1%1"AL
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