1983, 11-08 Permit: 83B-1419 ResidencePLAN NUMBER
APPLICATION/PERMIT
SPOKANE COUNTY - DEPARTMENT OF BUILDING & SAFETY
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
APPLICANT:
COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
STREET ADDRESS
E.14-700,
1.
LOT
2. t‘
OVNAER
3.
MAILING ADDRESS
14-7 t rD
4.
5.
BLOCK
CONTRACTOR
PARCEL NO.
SUBDIVISION
Tv%
Acs -
C�r�rJT:
1.4
PHONE
PHONE
ZC064-1- ZIoII
LEGAL DESCRIPTION:
ZP
4'&C ?
LICENSE EXPIRES
PHONE
Actual Set Backs in Feet to:
North South 44-5East 1 Z West Z
Residential Pr/-
Commercial ❑
Size of Parcel Zone Classification
ADDRESS
SHWit
DESIGNER
ZIP
Type Const.
Occupancy
Spr'nklered
❑Yes ❑No ❑Req'd.
PHONE
ADDRESS
ZIP
liew Const. Valuation I Remodeled Valuation
5(-1 it -5
Main Floor
t 27 2
Upper Floors
Total Bldg. Floor Area
L✓
Garage/Storage
Greenhouse
6.
CHANGE OF USE FROM
TO
Cover Deck
Uncv. Deck
Fin. Basement
3�Z
Unfin. Basement
e o
TYPE JEW ❑ ALT. ❑ AD' N. El RPL.
7. OF
WORK BLD. E PLMB. ❑ MECH. [1M.H.
❑ MVE.
❑ POOL
E OTHER
No. Baths
No. Floors
L
No. Fin. Rooms
No. Dwellings
Certifi. of Exempt.
or Variance
Required
Received
DESCRIBE WORK
8.
Shorelines/Flood Hazard
Yes❑ Not Applic. ❑
Number
Yes El NoP
Yes ❑ No7
Plans Required PI/
Received Or
VALUATION
9.
SOURCE
OF
UTILITIES
GAS
ELECTRIC
WATER /
PUBLIC OVi/
PRIVATE ❑
SEWAGE/
SEPTIC ❑
SEWER ❑
Ownership
Public ❑ Private V
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. Al provisions of laws and ordinances governing this type of
work will be complied with whether specified her- • or n'/ . The granting of a permit does not presume to give au-
thority to violate or cancel the prov sions of any • s /e or to 1 law regulating construction or the performance
of construction. SEE REVER OR REO i13n)r '
SIGNATURE OF
OWNER OR AGENT
SPECIAL APPROVALS
PRELIM. FINAL DATE
APPLICATION
DATE
Env. Health
Lu( J
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
6T,
tip
SPECIAL CONDITIONS: (SEE ' EVERSE SIDE FOR NOTICE)
Ar? -T‘54- Z3Zc'Z
PERMIT IS NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
FEES COLLECTED
Building • EC)
Plumbing
Mech.
Plan Check
SEPA
Modular/
MFG. Home
Other (Specify)
TOTAL $
PERMIT NUMBER
IIIrf`f1PY
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATE "SS1 DO 8 t_PERMIT NO. 11-1,9c5
,9o *366,0021-2 36nO OTAL