1983, 12-14 Permit: 83B-2504 ResidencePLAN NUMBER
APPLICATION/PERMIT
SPOKE NE 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
1. t .\\ `1(a2 -S5544-1 040-C
PARCEL NO.
2.
LOT
5
4OCK
SUIDIVISION
?6-
3.
OWNER
ASCO co tL-0E ,
PHONE
PHONE
4.S3` ?
LEGAL DESCRIPTION:
MAILING ADDRESS
W. 4r!,c0 6. (Z '-) Cs0 E(A)
ZIP
Ram
Actual Set Backs in Feet to:
1
11 LI ` West
Classification
12 --‘North . East t
jSouth .l - 1
4.
5.
CONTRACTOR
ADDRESS
DESIGNER
LICENSE EXPIRES
PHONE
Sizqaf Parcel
ZIP
Type Const.
Occupancy
rn-1
Residential
Commercial ❑
Spr'nklered
❑Yes ❑No ❑Req'd.
PHONE
ADDRESS
ZIP
„Kew Const. Valuation Remodeled Valuation
V5 el
Main Floor
2Fsg
Upper Floors
5eib
Total Bldg. Floor Area
Garage/Storage
Greenhouse
6.
CHANGE OF USE FROM
TO
Cover Deck
Uncv Deck
Fin. Basement
Unfin. Basement
TYPE B EW ❑ ALT. ❑ AD' N. ❑ RPL. ❑ MVE.
7. OF
WORK BLD. ❑ PLMB. ❑ MECH. ❑ M.H. CIPOOL
❑ OTHER
No. Baths
No. Floors
Certifi. of Exempt.
or Variance
Required
Received
No. Fin.
Rooms
Yes❑ Noll/
Yes ❑
No FT
8. DESCRIBE WORK
"�- ✓�V�rvC_�
Shorelines/Flood Hazard
Yes El NotApplic. ❑
No. Dwellings
Number
Plans Requ'red
Received p2'
VALUATION
9.
SOURCE
UTILITIES
GAS
ELECTRIC
WATER
PUBLIC
PRIVATE ❑
SEWAGE
SEPTIC CC
SEWER ❑
Ownership
Public ❑ Private
I hereby certify that I have read and examined this appl'cation 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 REV E S; E FOR REQUIRED INSPECTIONS
SIGNATURE OF
OWNER OR AGENT
SPECIAL APPROVALS
PRELIM. FINAL DATE
Env. Health
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
f
1.4
17/
/Z
APPLICATION
DATE — l
403
SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PERMIT IS NONTRANSFERABLE
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 $
34.0 .c2c'
PERMIT NUMBER
CII rnov
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATE *QED 1 4- 8 3
PERMIT4S0.4z *366.0 u1 AL