1983, 10-07 Permit: 83B-0129 MH PLAN NUMBER y APPLICATION/PERMIT .. PERMIT UMBER
SPOKANE COUNTY - DEPARTMENT OF BUILDING & SAFETY 83 v ern
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(1) NORTH 811 JEFFERSON /SPOK/ E,WASHINGTON 99260/(509)456-3675
APPLICANT: COMPLETE NUMBERED SPACES— PRESS HARD TO MAKE 3 COPIES
1. KEETADDRESS �( PARCEL NO. Z
2. LOT BLCSCK SUBDIVISION LEGAL DESCRIPTION: IA I/ 9
OWNER 1, 10N1 PHONE ("Z' "I` 'V ' ��•l I�C) tO
3. -Mil r�AL ( , opa� 2_ -0,23 6>c)- �
MAILING ADDRESSAct l Set Backs in Feet to:
�O '� `� J 3 ZIP-1. 9.0-37
jj7 0I� I
� ��� / North South 3 V East 3 I West � � / % * ;t �", ,J
CO TRA Tj� ICENSE EXPIRES H NE Size of Par%1_ Zene Classification Residential"
4. <��G , �t1 A��11L�(' Commercial❑ A `, I; IJ 0
ADDRESS ZIP Type,MI Oncy !�� Sprinklered +..
_ 3J Dyes 0 N ❑Req a.
DESIGNER PHONE New Const.Valuation Remodeled Valuation Total Bldg.Fioor Area rn r U t
ADDRESS ZIP Main Floor Upper Floors Garage/Storage Greenhouse -
CHANGE OF USE FROM TO Cover Deck Uncv.Deck Fin.Basement Unfin.Basement
6. _
� No.Baths No.Floors No.Fin.Rooms No.Dwellings
TYPE .�f NEW ❑ ALT. ❑ AD'N. ❑ RPL. ❑ MVE.
7. OF
0 BLD. 0 PLMB. 0 MECH. H. ❑ POOL ❑ OTHER Certifi.ofExempt. Required Yes No❑ Numbe
or Variance Received Yes Non ✓6j `9
WORK 3/ 3
DESCRIBE WORK � ��T� Shorelines/Flood Hazard Plans Required 0
8. �0 -+� C'
e31Lv'_l770) Yes❑ Not Applic.0 Received 0
VA,13172 "pp.. SOOUFCE GAS ELECTRIWATEPUBLIC SEPTIC OwnershipFEES COLLECTED
9• UTILITIES PRIVATE 0 SEWER❑ Public 0 Private
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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- Building
thority to violate or cancel the provisions of any other state or local law regulating construction or the performance
of construction.SEE REVERSE SID FOR REQUIRED INSPECTIONS Plumbing
SIGNATURE OFAPPLICATION /� If..,, AOWNER OR AGENT j
____ ,41111111111111111111111.1111
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A�� t'gt, &ALE. I = 40
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