1983, 03-25 Permit: 83A-2253 ResidencePLAN NUMBER APPLICATION _ _ � PERMITNUMBER
SPOKANE COUNTY - DEPARTMENT OF BUILDING & SAFETY
NORTH 811 JEFFERSON / SPOKANE, 4SHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 3 COPIES
02, 366.00
STREET ADDRESS PARCEL NO. 366.00 TL
1. 5- ..,lQ)\s Z P-1-5$ -0A_k 15
LOI
2. '►`�
BOCK
SUBDIVISION
LEGAL DESCRIPTION:
366.00 CK ,x
A 0.00 CH�
1904
OWNER
m
PHONE
PHONE
_gam
3.
MAILING ADDRESS
10 ^jl�� 1/�
Z p
f -V4-
1
Actual Set Backs in Feet to:
North 54� South �r East � i West to
CQt4TRACTOR
LICENSE EXPIRES
PHONE
Size of Parcel
Zone Classif ication
Residential
pa rC.•
}C; lc—so
1 46. Sa a�
Commercial ❑
Required
4. ADDRESS
ZIP
Type Const.
Occupancy
Sprinklered
Yes❑ No❑
-_Z')
R'S �^-4 1
❑Yes ❑No ❑Req'd.
8. ' ( VC AJOE
DESIGNER
PHONE
New Const. Valuation
Remodeled Valuation
Total Bldg. Floor Area
ELECTRIC
WATEW
PUBLIC
c -tr
.�-
FEES COLLECTED
5.
ADDRESS
ZIP
Main lo`or�
Upper Floors
Garage/Storage gee
Greenhouse
Public ❑Private
CHANGE OF USE FROM
TO
Cover Deck
Uncv. Deck
Fin. Basement
Unfin. Basement
No. Baths No.
Floors
No. Fin= ms
No. Dwellings
TYPE M EW ❑ ALT. El AD' N. ❑ RPL. El MVE.
Z
t
1
7. OF ❑ OTHER
's' "LD' ❑ PLMB. ❑ MECH. ❑ M.H. ❑ POOL
CeVaziooffExempt.
Required
Yes❑ N
Number
WORK
or
Received
Yes❑ No❑
DESCRIBE WORK
Shorelines/ Flood Hazard
Plans Required /
8. ' ( VC AJOE
Yes Not Applic. ❑
Received E7
VALUATION
SOOURCE
GAS
ELECTRIC
WATEW
PUBLIC
SEPVAF
1
Ownership
FEES COLLECTED
9•
UTILITIES
PRIVATE ❑
SEWER El
Public ❑Private
1 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
cc
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
of construction. SEE REVERSE SIDE FOR REQUIRED INSPECTIONS
Plumbing
SIGNATURE OF — rAPPLICATIOD
OWNER OR AGENT _, 1 , DATE > Z �—' _3 --
Mach.
SPECIAL APPROVALS SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PRELIM. FINAL DATE
Env. Health
Planning
Engineer
t7c-3Z
Utilities
SEPA
Plans $IPS t��P►rJ PERMIT IS NONTRANSFERABLE
Exam. PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
Building IN 180 DAYS
Tech. P *."Q -.
Plan Check
SEPA
Modular/
MFG. Home
Other (Specify)
17
TOTAL $= I
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATE ISSUE — PERMI7 �. �' z k 3 6 6. 0 0 �-&AL