1983, 03-01 Permit: 83A-1395 Residence PLAN NUMBER
421'53 APPLICATION/PERMIT PERMIT NUMBER
SPOKANE COUNTY — BUILDING CODES DEPARTMENT ids
NORTH 811 JEFFERSON / SPOKANt,WASh4NGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES- PRESS HARD TO MAKE 3 COPIES
JOB ADDRESS
/ � J' / LEGAL DESCRIPTION - SEE ATTACHED
1. LOT BLOCK SUBDp{ISION PARCEL NUMBER/S
2. 2 / / Ll.iJ1 '
OW ER PHONE oc"2. �%`-i`4/ ,,-i�,e,_.-.7!..
ADDRESS ( ' . �) ZIP Actual Set Backs in Feet u' 2 * * 5 8 0 0
\ .'.57 .,% 11, .(i..4a,,,,,l iiC,i/C,t, ilk' c 6' North :2-5 ISouth East 14- (West l'7- * 3 5 8 0 0
•CONT ACTOR PHONE Size of Parcel Z ne Cla ification
.7—_,-1.1 .s /9----,c J 100>< 0 5.1gi�KL �I��'/W�AI' A * C. 0 2
4' ADDRESS ZIP Type st. Occu anc Sprinl�ler�d ' 1 Z Lr_
❑Yes ❑No 0 Req'd.
DESIGNER PHONE Valuation Building Area in Sq. Ft. 0 2`2 J- 3
57 4- 0 5. ADDRESS ZIP Main Flo Upper Floors Garage AX Storage 6 �' -
12q1
CHANGE OF USE FROM TO Area of
Decks Finished Basementt/ Unfin. Basement
6. x-74. .
No aths No. Stories No. Rooms No. of Dwellings
TYPE X NEW 0 ALT. 0 AD'N. 0 RPL. ❑ MVE. 7j
7, OF 0 OTHER
WORK ' BLD. 0 PLMB. 0 MECH. 0 M.H. 0 POOL CERTIFICATE Req'd. Rec'd. Not 1,,:1,4.9',d.of EXEMPTION �/
DESCRIBE WORK Enum.Dist. I Location (Area) FEES COLLECTED
8. I G� LAI �p
VALUATION'' SOURCE 1 G S LECTRIC I ATER I SEWERownership ,//GSE CODE
9. UTILITIES I l I I C - 1 L ,,
Public 0 Private l l Single $
I hereby certify that I have read and examined this application and have read the "NOTICE" provisions included AQ
on reverse side, and know the same to be true and correct. All provisions of laws and ordinances governing this Building '5.v -
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 INSPECTIONS Plumbing
DATE OF APPLICATIONi - a 3 - r5 3 SIGNATURE OF APPLICAN -�7 Mech.
SPECIAL APPROVALS SPECIAL CONDITIONS:
NAME DATE /' ii 1 Plan Check
Env. ealt `_.`�`-r, tAC._ 2,23 - `,.Iii rL�jkf 221 15.J )
0/- SEPA a
C
Planning L
- LL
Fire Marshall Mobile Home -
'u
Co. Engineer Other(Specify)
'EFIlrieVe 3
Utilities
TOTAL $__a _
Plans Exa er
,7���;0.� - , WHEN MACHINE VALIDATED IN THIS SPACE,
- SEPA hecklist THIS BECOMES A PERMIT.
�4dia an _ PERMIT IS NONTRANSFERABLE Ot5�h. 0 �—;$t �
3' 1 �) 9, �j Z * 3 58. ,0 a
0,, PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE DATE ISSUED PERMIT NO. TOTAL
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