1983, 08-02 Permit: 83A-7297 MHRequired YesE No
Received Yes[' NoV�
Ownership
Public' Private
PLAN NUMBER
APPLICATION/PERMIT
SPOKANE COUNTY — DEPARTMENT OF BUILDING & SAFETY
NORTH 811 JEFFERSON / SPOKANE, WASAINGT'JN 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
1.
STREET ADDRESS t_
E952_0
LOT BLOCK SUBDIVISION
2. "1 2 L-ct.COnni NA.
3
OWNER
\,) 1 C L A S Ititn
MAILING ADDRESS
SZ -.Q `7 k
4.
CON RACTOR f��
't r1 t L �L 1Z -T1 l.,t--
PHONE
LICENSE EXPIRES
PHONE
ZIP
PHONE
PARCEL NO. 2o5 Li a 1I 07
LEGAL DESCRIPTION:
Actual Set Backs in Feet to:
North .3S 'South '55"!East E i West
Size of Parcel
(.c 7` 1 2
ADDRESS ZIP Type Const. Occupancy i
DESIGNER
5.
ADDRESS
CHANGE OF USE FROM
PHONE
ZIP
TO
TYPE EW ❑ ALT. ❑ AD' N. 'I' RP . II MVE.
7. OF ❑ OTHER
WORK O BLD. ❑ PLMB. C MECH. M.H. -1 POOL
8
DESCRIBE WORK
Sty 0 Uvi E ftkF• iv�St�I.L flT��Y, 1`!x 1 D)
VALUATION SOURCE GAS ELECTRIC WA R
PLIC -2
9. az1'pO 0 UTILLIITIES F RNA E E
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 the provisions of any other state or local law regulating construction or the performance
of construction. SEE REVERSE SICZE FOR REQUIRED INSPECTIONS
SIGNATURE OF
OWNER OR AGENT
SEWAGE
SEPTIC 0
SEWER ❑
New Const. Valuation
Zorag Classifjcation
Residential ?I'
Commercial C
Spr'nklered
i -:Yes ENo EReq'd.
Remode ed Valuation
Upper Floors
Cover Deck
No. Baths
Tota141Floor Area
411090
Garage/Storage
Uncv. Deck
No. Floors
Certifi. of Exempt.
or Variance
Greenhouse
Fin. Basement
No. Fin. Rooms
Shorelines/Flood Hazard
Yes.'-: Not Applic.
i
SPECIAL APPRO AAA�,S
PRELIM. FINAL DATE
74Env. Health
tic
Planning
Fire
Prevent.
Engineer
Utilities
APPLICATION
DATE
SPECIAL Cr NDITI • : (SEE REVERSE SIDE FOR NOTICE)
"(14-07;/-4(
SEPA
Plans
Exam.
Building
Tech.
EAST rQ ( 1,)
PERMIT IS NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
Unfin. Basement
No. Dwellings
Number
Plans Required E
Received r
FEES COLLECTED
Building
Plumbing
Mech.
Plan Check
SEPA
Modular/ iA*,\ —
MFG. Home
Other (Specify)
TOTAL $
PERMITUMBER
S -7/7
/ * X50.00
729.62
0802-83
2 6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DAT riI UEb 2 - 8 3
PERMIft4.9 7 z
*50.00OQTAL
y
•