1983, 04-11 Permit: 83A-2782 Addition PLAN NUMBER APPLICATION/PERMIT . PERMIT NUMBER
SPOKANE COUNTY — DEPARTMENT OF BUILDING & SAFETY 834 ,2fg2
v NORTH 811 JEFFERSON/SPOKANE,WASHINGTON 99260/ (509)456-3675
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
STREET ADDRESS PARCEL NO.
1. E - \-Za,-`5 Ger t4 0:2'34-7___- i02.P
LOT BLOCK SUBDIVISION LEGAL DESCRIPTION:c. tP-rtlyf-b =" TS,....._x._t S4, V.).le Lh f`
2. `f. t:.,?C.' CSF -rv....tei. GKC., N:' OO r frs'. ''?.a.5'
OWNER PHONE PHONE
3. iFC,(A-1•- k)-%',-ivecz1.>v-c 6.7
MAILING ADDRESS ZIP Actual Set Backs in Feet to:
C-. 1 Xe 6:01+ 461.2-k North !South East 13` I West
CONTRACTOR �� LICENSE EXPIRES PHONE ,t Size of Parcel Zone Classification Residential e
4. pf IV B i C u Y ONS..s•\- I,p_4(18-7 z'5 `t 406- -TC' SC -C`)C Commercial 0
ADDRESS ZIPt Type Const. Occupancy Sprinklered
7- 2. C-/)<C-/)< 1 -\1 ClC'iU YID :"J ❑Yes ❑No ❑Req'd.
DESIGNER PHONE r��rwConst.Valuation Remodeled Valuation Total Bldg.Floor Area
5. It-3,6l 114
ADDRESS ZIP Main Floor Upper Floors Garage/Storage Greenhouse
i'14 _
CHANGE OF USE FROM TO Cover Deck Uncv.Deck Fin.Basement Unfin.Basement
6. -- — —
No.Baths No.Floors No.Fin.Rooms No.Dwellings
TYPE ❑ NW E ALT. 'RAD'N. ❑ RPL. ❑ MVE.
7. OF
WORK '�' BLp. ❑ PLMB. ❑ MECH. ❑ M.H. ❑ POOL ❑ OTHER Certifi.of Exempt. Required Yes Noll Number
or Variance Received Yes❑ No❑
DESCRIBE WORKShorelines/Flood Hazard Plans Required F7
8. A X D l T lC jN "Co ��o +•te` i OCNC Yes CI Not Applic.❑ Received i
-SOURCE SOURCE GAS ELECTRIC WATE SEWAGE/. Ownership
OF PUBLIC SEPTIC / FEES COLLECTED
9• UTILITIES PRIVATE❑ SEWER 0 Public 0 Private Cd
I hereby certify that I have read and examined this application and have read the "NOTICE" provisions included on"' 54-,co
reverse side, and know the same to be true and correct. All provisions of laws and ordinances governing this type of Building 54
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 OF APPLICATION
OWNER OR AGENT DATE Mech.
SPECIAL APPROVALS SPECIAL CONDITIONS:(SEE REVERSE SIDE FOR NOTICE)
PRELIM. NAL DATE Plan Check
Env.Health
fp SEPA
Planning Modular/
Fire MFG.Home d
Prevent. p
C.)
Engineer Other(Specify) LLI
J_
Utilities a) LL
TOTAL $ ./ '`
SEPA
PERMIT IS NONTRANSFERABLE WHEN MACHINE VALIDATED IN THIS SPACE,
Plans THIS BECOMES A PERMIT.
Exam. PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
Building rJ IN 180 DAYS DATE7SSU [3- 1 — NDPERMIT� .l7, 2 z * 5 4 0 0 ��tAL
Tech. `
BELKNAP
AiiiVmmil. iHilliiiMill INDUSTRIES
DATE
JOB TITLE (-----
!I-"I7:-.1 i' r,).. /',: r ! h
JOB LOCATION 1 8 c,
OWNER/CONTRACTOR CONTACT
ADDRESS PHONE
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