1983, 11-07 Permit: 83B-1363 Insert PLAN NUMBER APPL i(CAT ION/PERMIT PERMIT NUMBER
SPOKANE COUNTY - DEPARTMENT OF BUILDING &SAFETY $' - 13623
NORTH 811 JEFFERSON/SPOKANE,WASHINGTON 99260/(509)456-3675
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES ; * _. n
•
STREET ADDRESS PARCEL NO. k i 0 0 '%
1. £. V54-%.z...‘ .
Z t ``z.Ta-k
LOT BLOCK SUBDIVISION LEGAL DESCRIPTION: A
2. -
OWNER PHONE PHONE C L-
3. • 44� C.LI f--1" e'tzG-Cap-74C. 1 i _ 0 7- 'I 3
MAILING ADDRESS ZIP Actual Set Backs in Feet to:
*C-. • 134-z% k Zz t-1 act'Z“.. North 'South liEast I West -- c; 4 C,
CONTRACTOR LICENSE EXPIRES PHONE Size of Parcel Zone Classification Residential
4. � � _ Commercial 0
ADDRESS ZIP -Type Const. Occupancy Sprinklered
KA& ❑Yes ONo ❑Req'd.
DESIGNER PHONE New Const.Valuation Remodeled Valuation Total Bldg.Fioor Area -
5.
ADDRESS ZIP Main Floor Upper Floors Garage/Storage Greenhouse
CHANGE OF USE FROM TO Cover Deck - Uncv.Deck Fin.Basement Unf in.Basement
6.
JAD'N. 0 RPL. ❑ MVE. No.Baths No.Floors No.Fin.Rooms No.Dwellings
TYPE I‘NEW 0 ALT. 07 WORK 0 BLD. 0 PLMB. 1p MECH. 0 M.H. 0 POOL ❑ OTHER Certifi.of Exempt. Required Yes No❑ Number
or Variance Received Yes❑ No❑
DESCRIBE WORK Shorelines/Flood Hazard Plans Required El
8.
ri 2 EV(..-4A-c-- 1 t.,,so 6a-T Yes CI Not Applic.0 Received El
VALUATION SOURCE GAS ELECTRIC PUBLICO SEPTIC GE Ownership FEES COLLECTED
9. UTILITIES PRIVATE El SEWER El Public El 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 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 REVERSE SIDE F• • REQUIRED INSPECTIONS Plumbing
SIGNATURE OF / 4
tql DATEATION ., ,
OWNER OR AGENT :z _ Mech. Z�.
SPECIAL AP/: • ALS S•ECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
Plan Check
PRELIM. FINAL DATE
Env.Health
SEPA
Planning
Modular/
Fire MFG.Home >-
Prevent. d
O
Engineer Other(Specify) v
W
J
Utilities LL.
TOTAL $ 2a•
SEPA
Plans PERMIT IS NONTRANSFERABLE WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
Exam. PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED 11 11 7 1 (�
cBuilding 4117 IN 180 DAYS DATE IdS SED 0 / B'. PERMIT 1103 6. 3 z * 2 0. 0 UTGTWL