1983, 05-17 Permit: 83A-4162 ResidencePLAN NUMBER
$3 -
APPLICATION/PERMIT
SPOKANE COUNTY — DEPARTMENT OF BUILDING & SAFETY
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 3 COPIES
STREET ADDRESS
1. a - -7( j 65)
BLOCK
2.
SUBDIVISI N
PHONE PJ ION
OWr�E�R
3. hl'rs I I�
MA INGA S
NG DjES
CONArq
4. ADDRESS
DESIGNER
5. ADDRESS
09
?7-7--()G
PARCEL NO. 1,4-54,5 0
LEGAL DESCRIPTION:
Actual Set Backs in Feet to:
North �OrSouth 0 East
West -3
LICENSE EXPIRES
PHONE
Size
ZIP
PHONE
Type Cpngt.
New Const. Valuation
ZIP
Main Flo9r
r=3 j
CHANGE OF USE FROM
6.
TO
Cover Deck
X1ne Classification�
Residentiat�'
Commercial ❑
Spr'nklered
❑Yes ❑No ❑Req'd.
Remode ed Valuation
(UPPer_Floors
7.
TYPE Vil./LD.
EW ❑ ALT. ❑ AD' N. ElRPL. ❑ MVE.
OF ❑ PLMB. ❑ MECH. El M.H. CI POOL ❑OTHER
WORK
No. a t9s
Total Bldg. Floor Area
Uncv. Deck
�%
No. Floors
Garage/Storage
C)
Greenhouse
Fin. Basement
Unfin. Basement
No. Fin. Rooms
No. Dwellings
Certifi. of Exempt.
or Variance
8.`�- � k
DE 5 C-r\Ic ki ] C -
WATER
9. I PUBLIC
PRIVATE ❑
VALUATION
SOURCE
F
UTILITIES
GA
ELECTRIC
Shorelines/Flood Hazard
Yes❑ Not Applic. ❑
Required Yes❑ No❑
Number
Received Yes❑ No❑
Plans Required
Received
SEWAGE
SEPTIC 01
SEWER 0
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 REVERSE SIDE FOR RE D INSPECTIONS
SIGNATURE OF . APPLICATIO
OWNER O' NT C- DATE--�'-�-� <�
SPECIAL APPROVALS SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
Env. Health �,
PRELIM. FINAL 1T Li�.c (ow
zj j ti z)
1
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
1
i
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
G
Other (Specify)
TOTAL
PERMIT NUMBER
1/62.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATE Igs51=_o17-83 41.6,25 *366.00a�
PERMIT NO. TOTAL
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. I •ct-Ntk.70..e., y
1 II/40
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