03-25 Permit: 83A-2255 ResidencePLAN NUMBER APPLICATION /PERMIT
SPOKANE COUNTY — DEPARTMENT OF BUILDING & SAFETY
/ NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
4.
ADDRESS
'5AMf
DESIGNER
APPLICANT: COMPLETE NUMBERED SPACES —PRESS HARD TO MAKE 3 COPIES
PARCEL NO.
SUBDIVISION LEGAL DESCRIPTION:
'yid ' � 1 e -W A%aw s
LTPHONE PHONE
OkA LL=>e4-r IA -Ge a 37
LICENSE EXPIRES PHONE
ZIP
PHONE
Actual Set Backs in Feet to,
North South 3 East t7. West t�
Size of Parcel Zone Classification Residential
Commercial C
T Const. OccupancySprinklered
W"-1 ❑Yes ❑No ❑Req'd.
New Const. Valuation Remodeled Valuation Total Bldg. Floor Area
5.
STREET ADDRESS
1.
F_ - i
LOT
BLOCK
2.
i(g,
Garage/Storage
Greenhouse
OWNER
M�P.i c: C)
3.
MAILING ADDRESS
4.
ADDRESS
'5AMf
DESIGNER
APPLICANT: COMPLETE NUMBERED SPACES —PRESS HARD TO MAKE 3 COPIES
PARCEL NO.
SUBDIVISION LEGAL DESCRIPTION:
'yid ' � 1 e -W A%aw s
LTPHONE PHONE
OkA LL=>e4-r IA -Ge a 37
LICENSE EXPIRES PHONE
ZIP
PHONE
Actual Set Backs in Feet to,
North South 3 East t7. West t�
Size of Parcel Zone Classification Residential
Commercial C
T Const. OccupancySprinklered
W"-1 ❑Yes ❑No ❑Req'd.
New Const. Valuation Remodeled Valuation Total Bldg. Floor Area
5.
Y
,
ADDRESS
ZIP
Main Floor Upper Floors
Garage/Storage
Greenhouse
CHANGE OF USE FROM
TO77
Cover Deck
Uncv. Deck
Fin. Basement
Unfin. Basement
6.
�--•
No. Baths No.
Floors
No. Fin. Rooms
No. Dwellings
TYPE L'lNEW ❑ ALT. ❑ AD'N. ❑ RPL. ❑ MVE.
I
%
Z
7. OF❑ OTHER
WOT,1< BLD. ❑ PLMB. MECH. ElM.H. El
Certifi.ofExempt.
Required
Yes❑ No
Number
or Variance
Received
Yes❑ No❑
DESCRIBE WORK
Shorelines/Flood Hazard
Plans
Required
S. '&j tp%0;_:t-4jL
G- "
Yes❑ Not Applic. ❑
Received T�
VALUATION
SOURCE
GAS ELECTRIC
I
pUB TE IC
E/
SEP TIC'
l
FEES COLLECTED
9•
UTILLIITIES
PRIVATE
PRIVATE ❑
SEWER El
Public ❑Private B'
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
_. -w
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
I
of construction. SEE REVERSE SIDE FOR REQUIRED INSPECTIONS
Plumbing
SIGNATURE OF APPLICATION
r)WNFR OR AGENT DATE
Mach.
SPECIAL APPROVALS I SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
Env. Health
Planning
Utilities
SEPA
Plans . F+c q i*-) PERMIT IS NONTRANSFERABLE
Exam. PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
Tech mg -6/:71 . IN 180 DAYS
Plan Check
SEPA
Modular/
MFG. Home
Other (Specify)
PERMIT NUMBER
02-
A
1905
276.00
276.00 TL
276.00 CK
0.00 Cf'i ,�i
TOTAL $ I
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT. 77
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