1983, 10-25 Permit: 83B-834 ResidencePLAN NUMBER
Cie
APPLICATQON/PERMIT
SPOKANE COUNTY — DEPARTMENT OF BUILDING & SAFETY
NORTH 811 JEFFERSON / SPOKANEAVA iINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 3 COPIES
STREET ADDRESS
1. 6. r11.3
LOT Id LOCK
� NIVI l?o A\// .
PARCEL NO. 2. 7 4 I
SUBDION
OWNER
3
MAILING ADDRESS
7 14— 1.°1\J icL. PP-
CONT�RAFTOP •
4. ADDR✓ESSSSSt��i/
lA�
PHONE PHONE
LEGAL DESCRIPTION:
LICENSE EXPIRES
Actual Set Backs in Feet to:
ZII /
62
PHONE Size of Parcel
cX. 13 -7
North 'South
East ( I West
Zone Classification
Residential 1�
Commercial D
ZIP
TypeCV'V
Occu ncy
Sprinklered
❑Yes ❑No ❑ Req 'd.
DESIGNER
5.
ADDRESS
PHONE
New Const. Valuation
Remode ed Valuation
Total Bldg. Floor Area
ZIP
CHANGE OF USE FROM
6.
TO
EllElEl
L� NN/
TYPE ALT. AD' N. RPL.
7. OF
WORK D. ❑ PLMB. ❑ MECH. ❑ M.H.
❑ MVE.
❑ POOL
D OTHER
Maine
Cover
No. Bat
Upper Floors
I c Dec,
Uncv.
Garage/Storage
Greenhouse
Fin. Basement
No. Floors
No. Fin. Rooms
Unfi BaaJysement
IU
No. Dwellings
Certif1. of Exempt.
or Variance
Required Yes❑ No❑
Received Yes No❑
Number
DESCRIBE WORK
8.
Shorelines/Flood Hazard
Yes C] Not Applic. ❑
Plans Required
Received
VALUATION
9.
SOURCE
UTILITIES
GAS
ELECTRIC
WATER
PUBLIC B'
PRIVATE ❑
SEWAG
SEPTIC
SEWER ❑
Ownership
Public 0 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 the provisions of any other state or local law regulating construction or the performance
of construction. SEE REVE
SIGNATURE OF
OWNER OR AG
IDE FOR REQUIRED INSPECT!
SPECIAL APPR • VALS
PRELIM. FINAL DATE
Env. Health
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
>-Fr2
i1 k
APPLICATION.
DATE _
AL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
6N -(, LA c (14-3 rad Gv t-zN c
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
Other (Specify)
TOTAL $
PERMIT NUMBER
035
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATE fSS ,E -D2 S - 8
PERMIT NIT. 3' z *) 2' O OTO AL