1983, 09-15 Permit: 83A-9091 ResidencePLAN NUMBER
APPLUCATI( �r(MIT
SPOKANE COUNTY - DEPARTh. T OF BUILDING & SAFETY
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 3 COPIES
STREET ADDRESS
1. l-,ti5
T"4
PARCEL NO.
ZaC57
LOT
2.'7
BLOCK
SUBDIVISION
OWNER .
INrb L..�
MAILING ADDRESS
PHONE
Yvti tki
PHONE
ZIP
LEGAL DESCRIPTION:
Actual Set Backs in Feet to:
North South 3(0
East
West t S
4.
CONTRACTOR
CW,C CON'S T ,
LICENSE EXPIRES PHONE
COL, '442(O
ADDRESS
:v. \
DESIGNER
5.
ADDRESS
'((ArvE rz
ZIP
aG1 2 t0
PHONE
'Type Const.
I )
Size of Parcel
127 1. t4.Z Ar ?2C,rc
Zone Classification
Residential few
Commercial E
Occupancy
'231
Sprinklered
❑Yes ❑No ❑Req'd.
New Const. Valuation
(v(vrj1U
Remodeled Valuation
Total Bldg. Floor Area
2.325
ZIP
Main Floor
I SCh
Upper Floors
Garage/Storage
1
Greenhouse
CHANGE OF USE FROM
6.
TO
Cover Deck
Uncv. Deck
Fin. Basement
Unfin. Basement
TYPE ®NEW ❑ ALT. ❑ AD' N. ❑ RPL. ❑ MVE.
7. OF
WORK BLD. ❑ PLMB. ❑ MECH. 17M.H. E POOL ❑ OTHER
No. Baths
No. Floors
Certifi. of Exempt.
or Variance
No. Fin. Rooms
Required Yes❑ No(
Received Yes El No❑
No. Dwellings
Number
DESCRIBE WORK
8.QShorelines/Flood Hazard
�C� • 6 AGC Yes❑ Not Applic. ❑
Plans
Required
Received i
VALUATION
9.
SOURCE
UTILITIES
GAS
ELECTRIC
WATER
PUBLIC ❑
PRIVATE
SEWAG
SEPTIC
SEWER ❑
Ownership
Public O Private Cd
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-
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
SIGNATURE OF APPLICATION
OWNER OR AGENT DATE
SPECIAL APPROVALS SP CIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PRELIM. FINAL DATE
Env. Health
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
PERMIT IS NONTRANSFERABLE
-`0
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
FEES COLLECTED
Building
Plumbing
Mech.
Plan Check
SEPA
Modular/
MFG. Home
Other (Specify)
TOTAL $
PERMIT NUMBER
S3ft-(10611
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATEIISSUEd 5 •8 3
PERMIT9N0.9. 1d
* 3 9 4. 0 0 SAL