1983, 09-06 Permit: 83A-8641 Insert PLAN NUMBER APPLICATION/PERMIT PERMIT NUMBER
SPOKANE COUNTY - DEPARTMIENT.OF BUILDING &SAFETY 63 A"- 4I _
NORTH 811 JEFFERSON/SPOKANE,WASHINGTON 99260/(509)456-3675
---v APPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 3 COPIES
STREET ADDRESS PARCEL NO. ;
1. c /t37/ /1_7, //l... l�C�rdci /e
LOT BLOCK SUBDIVISION LEGAL DESCRIPTION:
2. „ I.
OWNER PHONE PHONE
MAILINGyADDRESS "� ZIP Actual Set Backs in Feet to:
L L63,1 /,;r"[ �Yr/c..//e _ North 'South [East I West
CONTRACTOR -- LICENSE EXPIRES P O Size of Parcel Zone Classification Residential❑
4. ,5/77r�P �nle.r _ r.—7�c -Commercial❑
ADDRESS ZIP Type Const. Occupancy Sprinklered
Z/4004„ -c,�)iqa fJ ❑Yes ❑No ❑Req'd.
DESIGNER /� PHONE New Const.Valuation Remodeled Valuation Total Bldg.Floor 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. _ _
No.Baths No.Floors No.Fin.Rooms No.Dwellings
TYPE ❑ NEW ❑ ALT. ❑ AD'N. ❑ RPL. ❑ MVE.
7. OF
❑ OTHER
WORK ❑ BLD. ❑ PLMB. �,MECH. ❑ M.H. El POOL Certifi.of Exempt. Required Yes No❑ Number
or Variance Received Yes❑ No❑
DESCRIBE WORKShorelines/Flood Hazard Plans Required❑
8• 7-",-1 ,7/ lire/(9, J1 . t/7` , Yes❑ Not Applic.D Received ❑
VALUATION SOURCE GAS ELECTRIC WATER SEWAGE Ownership FEES COLLECTED
9. PUBLIC❑ SEPTIC❑
PRIVATE❑ SEWER❑ Public❑Private❑
UTILILITIES
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- Building
thority to violate or cancel the provisions of any other state or local law regulating construction or the performance
of construction.SEE REVERSE S DE FOR REQUIRED INSPECTIONS Plumbing
SIGNATURE OF < )' APPLICATION . , -g-
OWNER OR AGENT dieI" -°z= -' l DATE ' Mech. 2.O'VO
SPECIAL APPR ALS SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PRELIM. FINAL DATE Plan Check
Env.Health r
SEPA
Planning
Modular/
Fire MFG.Home >.
Prevent. a'
O
Engineer
Other(Specify) G3
JW
_
Utilities W
TOTAL $ 2-0-elf,
SEPA
MACHINE
Plans PERMIT IS NONTRANSFERABLE HEIS BECOMES A PERM TTED IN THIS SPACE,
Exam. PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
Building IN 180 DAYS �} (� L p 8 6 4.1 2 * 2 0.0 0 0
Tech. 511'-
7 DATE ISSU O U —u
PERMIT NO. TOTAL