1983, 03-11 Permit: 83A-1747 DamperPLAN NUMBER
APPLICATION/PERMIT
SPOKANE COUNTY — BUILDW CODES DEPARTMENT
NORTH 811 JEFFERSON / SPOKANE, UIN'GrON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
1.
2.
3.
JOB /7,,,,QDRESS
' 10706- /6( t%
LOT
BLOCK
SUBDIVISION
OW NE&L
ADDRESS
0 4)F17 C4-1
L
4. \iJ/yJ
LEGAL DESCRIPTION — SEE ATTACHED
ADD S
PHONE
7e2 t-057
PARCEL NUMBER/S
PHONE
(i; fob
Actual Set Backs in Feet
North 'South [East 'West
Size of Parcel
Zone Classification
Type Const.
Occupancy
Sprinklered
❑Yes ❑No ❑ Req'd.
DESIGNER
5' ADDRESS
PHONE
Valuation
Building Area in Sq. Ft.
ZIP
Main Floor
Upper Floors
Garage Area
Storage
CHANGE OF USE FROM
6.
TYPE
7. OF
WORK
TO
Area of Decks
Finished Basement
Unfin. Basement
❑ NEW
El BLD.
❑ ALT. ❑ AD'N. ❑ RPL. ❑ MVE.
❑ PLMB. .,MECH. ❑ M.H. 0 POOL
0 OTHER
No. Baths
No. Stories
No. Rooms
No. of Dwellings
DESCRIBE W
8.
VALUATION
9.
SOURCE
OF
UTILITIES
G F]r5
-
En
CERTIFICATE
of EXEMPTION
um. Dist. `Location (Area)
Req'd.
Rec'd.
Not Req'd.
ELECTRIC
WATER
SEWER
Ownership
Public ❑ Private ❑
USE CODE
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 authority 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 INSPECTNS
DATE OF APPLICATION 3 -f - c'
c
SIGNATURE OF APPLICANT
SPECIAL APPROVALS SPECIAL CONDITIONS:
NAME DATE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
Building -c ci:n
L'offrz-e-'
PERMIT IS NONTRANSFERABLE
FEES COLLECTED
Single $
Building
Plumbing
Mech. /'U0
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL $ /9-'6 ()
PERMIT NUMBER
6- A-(7+7
0/* *14.00
*14.006
A *000 0
17462
03.1 1 -83
z 6479,
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
012-111-83' 17'472 #1400° -
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE DATE ISSUED PERMIT NO. TOTAL