1983, 12-02 Permit: 83B-2205 MHPLAN NUMBER
APPLICATION/PERMIT
SPOKAkE COUNTY — DEPARTMENT OF BUILDING & SAFETY
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
J
1.
STREET ADDRESS
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
E. 17303 - Sth (`-eenacr .., W 16
-. 99.0
LOT BLOCK SUBDIVISION
2. 7
OWNER
I Aply \' �11?i ;Ni
PHONE PHONE
3. Bob Macy
PARCEL NO.
70 8,20001
145`' 2— iceO7
LEGAL DESCRIPTION:
MAILING ADDRESS
W. 2311 - 16th
Spokane
ZIP
Wa.
4.
ADDRESS
CONTRACTOR
Northwest Mobile Eones,Inc.
LICENSE EXPIRES
P-2909
ZIP
DESIGNER PHONE
5.
ADDRESS
CHANGE OF USE FROM
6.
ZIP
TO
TYPE ZNEW ❑ ALT. ❑ AD' N. RPL. ❑ MVE.
7. OF ❑ OTHER
WORK ❑ BLD. ❑ PLMB. ❑ MECH. X' M.H. ❑ POOL
Actual Set Backs in Feet to:
North South East West
Size of Parcel Zone Classification
Residential i{
Commercial E
nst
Occupancy
Sprinklered
:Yes JNo
New Const. Valuation
Main Floor
Cover Deck
Remode ed Valuation
Total Bldg. Floor Area
No. Baths
Upper Floors
Uncv. Deck
No. Floors
Garage/Storage
Fin. Basement
No. Fin. Rooms
Greenhouse
Unfin. Basement
No. Dwellings
Certifi. of Exempt.
or Variance
Required Yes❑ No❑
Received Yes Nor.:
Number
DESCRIBE WORK
8. (14x(�o�
Set lip Mobile Home
VALUATION
9.
SOURCE GAS I ELECTRIC
UTILITIES
OF
Shorelines/Flood Hazard Plans Required J
YesE NotApplic. C Received -,
WATER
PUBLIC
PRIVATE E
SEWAGE
SEPTIC
SEWER ❑
Ownership
Public ❑ 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 or not. The granting of a permit does not presume to give au-
thority to violate or cancel he . r. ions of any er state r local law regulating construction or the performance
of construction. SEE REV - -j. D - FOR RE •�i3' .; SECTIONS
SIGNATURE OF
OWNER OR AGENT
APPLICATION
DATE
SPECIAL APPROVALS
PRELIM. FINAL DATE
SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
Env. Health C. -6-V 0 Y ck fe,r-c a L C1, — j
(9
Planning kr b) :�:�1-(�3
. • ,S) 53 E1g3 -Sr
Fire
Prevent.
Engineer
Utilities
Ir3
SEPA
Plans
Exam.
Building
Tech.
PERMIT IS NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
FEES COLLECTED
Building
Plumbing
Mech.
Plan Check
SEPA
Modular/
MFG. Home 50 _ 00
Other (Specify)
TOTAL $ 50 no
PEWIT NUMBER
o
e •
07* *5000
*50006
A *000
3528
05-02-83
-4 6479
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
% 7
DATE PERMIT O _ PERMIT Z,2 0' 0' ) z
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