1983, 04-12 Permit: 83A-2855 Residence PLAN NUMBER - APPLICATION/PERMIT _ PERMIT NUMBER '
V Q SPOKANE COUNTY - DEPARTMENT OF BUILDING & SAFETY S-ZA -
& • .. ' t:ORTH 811 JEFFERSON /SPOKANE,WASHIIJflON.°9260/(509)456-3675
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
STREET ADDRESS PARCEL NO.
1. G . 72( tS-t•H 2..-- 5 3 zt-- oci be,
LOT BLOCK SUBDIVISION LEGAL DESCRIPTION:
2. €7., t c�v<.Kst.,'S .--"RE;--pL:4; 4-1
OWNERPHONE PHONE
3. --SArrir n 17`)P-c,"--,EL 0(24--51
MAILING ADDRESS ZIP Actual Set Backs in Feet to:
t'- -eG k: 1-3- -D...: f^.{q,'-)--13 North 'South ' ,'.6.-. East Z..7 I West Z,-1 i /
CONTRACTOR LICENSE EXPIRES PHONE Size of Parcel Zone Classification Residential Lit
4. y
oa X C30 CJ Q-( Commercial❑
ADDRESS ZIP Type Cong. Occupancy Sprinklered
A 3r-t,I R..� Yh.-1 ❑Yes ❑No ❑Req'd.
DESIGNER PHONE wConst.Valuation Remodeled Valuation Total Bldg.Floor Area
5. S .
t,2-S t44Q 7_
ADDRESS ZIP Main Floor Upper Floors Garage/Storage Greenhouse
1,920 C.gc, S72
CHANGE OF USE FROM TO Cover Deck Uncv.Deck Fin.Basement Unf in.Basement
6. CI
'1-. ,
No.Baths No.Floors No.Fin.Rooms No.Dwellings
TYPE EW ❑ ALT. ❑ AD'N. ❑ RPL. ElMVE. -112 2 C, t
7. OF WORK BLD. ❑ PLMB. ❑ MECH. ❑ M.H. ❑ POOL ❑ OTHER Certifi.of Exempt. Required Yes Nof Number
or Variance Received Yes❑ No❑
DESCRIBE WORK Shorelines/Flood Hazard Plans Required II ,
8• .. :.- iNl. Le; .rAMi..-`/ '�C' .�yetl3C Yes Not Applic.❑ Received C
VALUATION SOOURCE GAS ELECTRIC WATER
PUBLIC f / SEPTIC O� Ownership FEES COLLECTED
9 UTILITIES PRIVATE❑ SEWER X811 Public❑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 R ERSE SIDE FOR REQUIRED INSPECTIONS Plumbing
SIGNATURE OF ~ APPLICATION
OWNER OR AGEIL'>r- DATE 1-- S. - e33 Mech.
SPECIAL APPR ALS °°1 SPECIAL CONDITIONS:(SEE REVERSE SIDE FOR NOTICE)
PRELIM. FINAL Plan Check
Env.Health
4- ,pc SEPA
Planning
Modular/
Fire MFG.Home
Prevent. 0
O
Engineer 'C Other(Specify) V
Lu
LT.
Utilities TOTAL $3cc
SEPA
PERMIT IS NONTRANSFERABLE WHEN MACHINE VALIDATED IN THIS SPACE,
Plans THIS BECOMES A PERMIT.
Exam. I L) / PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
Building '_ `CC )' T(71 IN 180 DAYS DATE4 J D12 -8 3 PERMIT2& 5. 5 5 *3 5 0. 0 0 tIO AL
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