1983, 12-14 Permit: 83B-2505 ResidencePLAN NUMBER APPL ICA'' ION /PERMIT PERMIT NUMBER
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 PARCEL.NO.
1. � , %I..� 2�-T 4 ZSS44- -- 04-0"7
LOT BLOCK SUBDIVISION LEGAL DESCRIPTION:
2. %
1 4
j%C,lzn-z,
OWNER
PHONE
PHONE
3. SGd in 1+ ,fJ S
SS - a B07
MAILING ADDRESS
ZIP
Actual Set Back in Feet to:
'�SC) � Q N0 V Iz,L-u
CA C'Sy
North � I South East West Gj
CONTRACTOR
LICENSE EXPIRES
PHONE
Size of ParcelZoneeClassification
Residential
4.
0 �5o
16 ,
Commercial ❑
ADDRESS
ZIP
T pq nst.
Occupancy
Sprinklered
SAM
3 A
Dyes ❑No ❑Req'd.
DESIGNER
PHONE
Const. Valuation
Remodeled
Valuation
Total Bldg. Floor Area
4-
—
5.
ADDRESS
ZIP
Main Floor per Floors
Garage/Storage Greenhouse
iIZ3;-z •_
COiLs,
CHANGE OF USE FROM
TO
Cover Deck
Uncv. Deck
in. Basement
Unfin. Basement
6.
TYPE
No. Baths No.
Floors
No. Fin. Rooms
No. Dwellings
❑ ALT. ❑ AWN. ❑ RPL. ❑ MVE.
GJ
1
�EW
7 OF ❑OTHER
WORK; BLD. ❑ PLMB. ❑ MECH. ❑ M.H. ❑ POOL
Certifi. of Exempt.
Required
Yes❑ No
Number
or Variance
Received
Yes ❑ No ❑
QESCRIBE WORK
8'
Shorelines/ Flood Hazard
Plans Required
08^_X�
Yes E-1 Not Applic. ❑
Received EJ
VALUAIIIUN
9•
SOOUFCE
GAS
ELECTRIC
UBIC_
SEPTIC G®
Ownership/
FEES COLLECTED
UTILITIES
PRIVATE El
SEWER ❑
Public ❑ Private V
I hereby certify that I have read and examined this application and have read the "NOTICE"
provisions included on
p�
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
I�sJr,2
of construction. SEE REVERSE SIDE FOR REQUIRED INSPECTIONS
Plumbing
SIGNATURE OF APPLICATION
OWNER OR AGENT
L DATE
Mach.
SPECIAL APPROVALS SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PRELIM. FINAL DAT
Env. Health
Planning
Fire
Prevent.
Engineer
az,
Utilities
SEPA
Plans �! /</ PERMIT IS NONTRANSFERABLE
Exam. PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
Building / /
Tech. IN 180 DAYS
Plan Check
SEPA
Modular/
MFG.Home
Other (Specify)
TOTAL $ F>Zap I
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATE ISStiqD —14 — j PERMIT N�.S 0.5 z * 3 0 TCQrAL
CL
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