1983, 05-31 Permit: 83A-4630 Residence PLAN NUMBER APPLICATION/PERMIT PERMIT NUMBER
—1 43 SPOKANE COUNTY - DEPARTMENT OF BUILDING &SAFETY - ' 8-39 '4-.
, , �E NORTH 811 JEFFERSON /SPOKANE,WASHINGTON 99260/(509)456-3675
Cl APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
STREET ADDRESS PARCEL NO.
1. 50 i E4.1 yiFJ .
LOT BLOCK BDIVISION LEGAL DESCRIPTION:
22 1 f p$'� -01A N j15.
IWNER PHON 'ri PHONE v G « is (; i j �j
10 Y v Z�'IV (tk.
"3"1-
/may NIF r. U ['.,l� U C:
3• MAILIN ADDRESS LAI�/�, / p Actual Set Backs in Feet to:
7 — _ "...0 vv..,
o 1(4, North I Sout East 0 - (West /� r. ' (� ,, '.. `r
CONNTRACT R LICENSE EXPIRES HONE Size of Parcel neCl ifi ion Residential,8
4. ��'` 1OG'x ro ft& Commercial❑ 4 1 1,0 --ADDRESS ZIP Typ��eQ�gqnnss�� ccupancy Sprinklered
vfN ❑Yes ❑No ❑Req'd. - J-�` U
DESIGNER PHONE New
VVCo ,t.yalua'on Remodeled Valuation Total Bldg.Floor Area 6 4_ 7 9
5 ADDRESS ZIP Main F�r7 Upper7. Garage/Storage Greenhouse
CHANGE OF USE FROM TO Cover Uncv.D:Iti Fin.Basement Unf in.Basement
6.
TYPE y�/ El ALT. El AD'N. El RPL. El MVE. No.Bat No.Floors No.Fin ms No.Llvellings
7. OF WORK BLD. ❑ PLM B. El MECH. El M.H. El POOL ❑ OTHER Certifi.of Exempt. Required Yes❑ No❑ Number
or Variance Received Yes❑ No❑
DE CRI E WOR�K r/ Shorelines/Flood Hazard Plans Required
8 (� tCrC/ Yes❑ Not Applic.❑ Received
VALUATION SOURCE GAS ELECTRIC pUBLICR� SEWAG�VL Ownership FEES COLLECTED
9. UTILITIES PRIVATE 0 SEWER❑ Public 0 Priva
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 Building 3 G2.
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 REVERS IDE FO: • OUIRED INSPE TIONS Plumbing
116
SIGNATURE OF APPLICATION.--
OWNER OR AG NT ' - a► IC. — - -•-�. - DATE 5. - Mech.
SPECIAL APPR• 'ALS SPE AVONDITIONS:(SEE REVERSE SIDE FOR NOTIC )
PRELIM. FINAL DATE 4.t U(r ) -2.- _01 �v' -1t I i• + 2 _ __ ) ) Plan Check
Env.Health ` tsr�iV v /i �J�
1i""t 413)1 SEPA
Planning
Modular/
MFG.Home
Fire
Prevent. fL
O
EngineerOther(Specify) v
Pis/IC - W
Utilities rz
TOTAL $` 7. '
SEPA
/ PERMIT IS NONTRANSFERABLE WHEN MACHINE VALIDATED IN THIS SPACE,
Plans / ,it / 7 .�� THIS BECOMES A PERMIT.
Exa"'' A°/ Via' PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
Budding IN 180 DAYS � 55 _' 1 p 4 �jo ao
Tech. J X(e) DATEISSUED3 1 - 0 3 PERMIT NO: 3.0 2 *3 6 2. 0 0 TO AL
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