1983, 01-19 Permit: 83A-469 Addition PLAN/IUMBER APPLICA I IVN/PERMIT PERMITL,UMBER
SPOKANE COUNTY DEPARTMENT OF BUILDING &SAFETY i'5r'r - f
(1. 1 NORTH 811 JEFFERSON/SPOKANE,WASHINGTON 99260/(509)456-3675
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
STREET ADDRESS .. PARCEL NO.
1. Co -')r2. 1`a -Z45 33- C:
LOT BLOCK SUBDIVISION LEGAL DESCRIPTION: - ,'_ w. ' L 6' 0 0
2. 4 -? Jay VItc.t,o 4.t L.L. 2^'fP
OWNER PHONE PHONE
MAILING ADDRESS ZIP Actual Set Backs in Feet to:
S , CCA-Z-.4_ k.45-1-0. 6k6kZ.C{r North 'South (00 i East I west ICA' /.
CONTRACTOR LICENSE EXPIRES PHONE Size of Parcel h Zone Classification Residential L( — ( — 3 3
` Pavvve gorc 140 N lii OK Commercial 0
4. ADDRESS ZIP Type Const. Occupancy Sprinklered ' n,
t=h.rvt,E --rte 12..'- ❑Yea 0N ❑Req'd.
DESIGNER PHONE New Const.Valuationemodeled Valua Total Bldg.Floor Area
5. / on,acv i"3�e
ADDRESS ZIP Main Floor Upper Floors Garage/Storage Greenhouse
p
CHANGE OF USE FROM TO Cover Deck - Uncv.Deck Fin.Basement Unfin.Basement
6.
� No.Baths No.Floors No.Fin Rooms No.Dwellings
TYPE 0 NEW 0 ALT. PIAD'N. ❑ RPL. 0 MVE. — ‘
7. OF /
WORK I"BLD. 0 PLMB. 0 MECH. 0 M.H. 0 POOL 0 OTHER Corti&of Exempt. Required Yes No>• Number
orVariance Received Yes No
DESCRIBE WORK Shorelines/Flood Hazard Plans Required I2
8. b 1 T t k X.1 Lc-) 104 C^ R / �/ Yes❑ Not Applic.❑ Received Q
VALUATION SOURCE GAS ELECTRIC PUBLIC R SEPTIC Gd whip FEES COLLECTED
9. UTILITIES PRIVATE❑ SEWER❑ Public❑Private GIS
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 24(,.<1.51°
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 REQUIRED INSPECTIONS Plumbing
SIGNATURE OF APPLICATION
OWNER OR AGENT DATE Mech.
SPECIAL APPROVALS SPECIAL CONDITIONS:(SEE REVERSE SIDE FOR NOTICE)
Plan Check
PRELIM. FINAL DATE
Env.Health ilia 1_rq SEPA
Planning Modular/
MFG.Home y,
Fire a
Prevent. O
Engineer Other(Specify) W
J_
Utilities 24.
TOTAL $— Cr)C!
SEPA
WHEN MACHINE VALIDATED IN THIS SPACE,
Plans PERMIT IS NONTRANSFERABLE THIS BECOMES A PERMIT.
Exam. Yi7fetS, PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED n l n n
Building '/ii j� IN 180 DAYS DATE....ED 9 -
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