1983, 07-05 Permit: 83A-6138 Addition PLAN NUMBER APPLICATION/PERMIT P RMITNUMBER
SPOKANE COUNTY — DEPARTMENT OF BUILDING & SAFETY 8-5 A 61,38
1
NORTH 811 JEFFERSON /SPOKANE,WAIHINGTON 99260/(509)456-3675imw4rmism.......... ....
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
STREET ADDRESS PARCEL NO.
1. Ia'�i r5 5 - - ' -2-r---?+1 — O 27
LOT BLOCK SUBDIVISION LEGAL DESCRIPTION:
2. 10 �-- I`467e7K , �1- - t"4N4
INAR . M PHONE PHONE
IMI -
3 MAIL "d ADDRESS / Actual Set Backs in Feet to: [�1'j i 5 &7 _ � I w North 'South a 2. I EastZ Z! (West /
CONTRACTOR , •, _l LICENSE EXPIRES ;WANE 7/� Siizzgofoff Parcel ZFRne,_Classifi tion Residential.
GIT Ct.,jW 1 ki 4 �'1V c"r o"6— /v I �t t,? I�'7 ' ` 1 tc, Commercial❑
4. ADgRESS; +o I-II � � 1." f 7 �O TYPeCpnst. OCc�a/ ray ❑Yes Sprinklered❑No ❑Reg'd.
DESIGNER *PHONE New Const.Valuation 4-�1JRemodeled Valuation Total Bldg.Floor Area 02 * * 7 5, 0 0
J.
CCS 11 5
70 0
* L
ADDRESS ZIP Main Floor Upper Floors Garage/Storage Greenhouse
2-27 A * 000 E
CHANGE OF USE FROM TO Cover Deck Uncv.Deck Fin.Basement Unf in.Basement
6. 597,f 2
TYPE ❑ EW ❑ ALT. ,4D'N. El RPL. El MVE. No.Baths No.Floors No.Fin.Rooms No.Dwellings
t;6-c9-8
7. OF WORK Ar BLD ❑ PLMB. ❑ MECH. ❑ M.H. ❑ POOL ❑ OTHER Certifi.of Exempt. Required Yes No❑ Number ? 6 4 7 9
or Variance Received Yes No❑
DESCRIBE WORK Shorelines/Flood Hazard Plans Required-�
8. i a ''A'c--a21-1. Yes❑ Not Applic.❑ Received lar
VALUATION SOURCE GAS ELECTRIC WATER SEWAGE/ Ownership f�' FEES COLLECTED
9 OF PUBLIC SEPTIC Public El Private
UTILITIES PRIVATE❑ SEWER❑
I hereby certify that I have read and examined this application and have read the "NOTICE" provisions included on r
reverse side,and know the same to be true and correct. All provisions of laws and ordinances governing this type of Building / ✓-
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 REVER E SIDE FOR REQUIRED INSPECTIONS Plumbing
SIGNATURE OF APPLICATION
OWNER OR AGENT . ��Z DATE `` � —8p 3
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SPECIAL APPROVALS SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PRELIM. FINAL DATE Plan Check
Env.Health t\I if'•C' 1 1
SEPA
Planning Modular/
MFG.Home
Fire 12-
`
Prevent.
O
Other(Specify) O
Engineer y,l
-I
Utilities 75
TOTAL $
SEPA
PERMIT IS NONTRANSFERABLE WHEN MACHINE VALIDATED IN THIS SPACE,
Plans p, THIS BECOMES A PERMIT.
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Exam. 0 ! PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED z 7
Building (XL IN 180 DAYS DATE t�SUEO 0 5 —S 3 PERMIT bol 8 5 * / 5' O O TO AL
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